scholarly journals A Large Spatial Survey of Colistin-Resistant Gene mcr-1-Carrying E. coli in Rivers across Taiwan

2021 ◽  
Vol 9 (4) ◽  
pp. 722
Author(s):  
Ching-Hao Teng ◽  
Pin-Chieh Wu ◽  
Sen-Lin Tang ◽  
Yi-Chen Chen ◽  
Ming-Fang Cheng ◽  
...  
Keyword(s):  
Virulence Genes ◽  
Antimicrobial Agents ◽  
Antibiotics Resistance ◽  
Natural Environments ◽  
Natural Habitats ◽  
E Coli ◽  
Life Threatening ◽  
Group A ◽  
The Relationship ◽  
Entire Island

Background: Colistin is one of the last-line antimicrobial agents against life-threatening infections. The distribution of the colistin resistance gene mcr-1 has been reported worldwide. However, most studies have focused on the distribution of mcr-1-positive bacteria in humans, animals, food, and sewage; few have focused on their distribution in natural environments. Method: We conducted a large spatial survey of mcr-1-positive Escherichia coli at 119 sites in 48 rivers, covering the entire island of Taiwan. We investigated the relationship between the livestock or poultry density in the surveyed riverine area and the number of mcr-1-positive E. coli in the river water. We then sequenced and characterized the isolated mcr-1-positive plasmids. Results: Seven mcr-1 positive E. coli were isolated from 5.9% of the sampling sites. The mcr-1-positive sites correlated with high chicken and pig stocking densities but not human population density or other river parameters. Four of the mcr-1-positive E. coli strains harbored epidemic IncX4 plasmids, and three of them exhibited identical sequences with a size of 33,309 bp. One of the plasmids contained identical 33,309 bp sequences but carried an additional 5711-bp transposon (Tn3 family). To our knowledge, this is the first demonstration that mcr-1-carrying IncX4 plasmids can contain an insertion of such transposons. All mcr-1-positive isolates belonged to phylogenetic group A and harbored few known virulence genes. Conclusion: This study showed a positive relationship between the number of mcr-1-positive sites and high livestock and poultry density. The sequencing analyses indicated that the epidemic plasmid in the mcr-1 isolates circulates not only in humans, animals, and food but also in the associated environments or natural habitats in Taiwan, suggesting that the surveillance of antibiotics-resistance genes for livestock or poultry farm quality control should include their associated environments.

scholarly journals Molecular characterisation of antimicrobial resistance and virulence genes in Escherichia coli strains isolated from diarrhoeic and healthy rabbits in Tunisia

2020 ◽  
Vol 28 (2) ◽  
pp. 81
Author(s):  
Raouia Ben Rhouma ◽  
Ahlem Jouini ◽  
Amira Klibi ◽  
Safa Hamrouni ◽  
Aziza Boubaker ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Antimicrobial Resistance ◽  
Virulence Genes ◽  
Antimicrobial Agents ◽  
Antibiotic Resistance Genes ◽  
Virulence Gene ◽  
Diffusion Method ◽  
Class 1 Integron ◽  
E Coli ◽  
Class 1

The purpose of this study was to identify <em>Escherichia coli</em> isolates in diarrhoeic and healthy rabbits in Tunisia and characterise their virulence and antibiotic resistance genes. In the 2014-2015 period, 60 faecal samples from diarrhoeic and healthy rabbits were collected from different breeding farms in Tunisia. Susceptibility to 14 antimicrobial agents was tested by disc diffusion method and the mechanisms of gene resistance were evaluated using polymerase chain reaction and sequencing methods. Forty <em>E. coli</em> isolates were recovered in selective media. High frequency of resistance to tetracycline (95%) was detected, followed by different levels of resistance to sulphonamide (72.5%), streptomycin (62.5%), trimethoprim-sulfamethoxazole (60%), nalidixic acid (32.5%), ampicillin (37.5%) and ticarcillin (35%). <em>E. coli</em> strains were susceptible to cefotaxime, ceftazidime and imipenem. Different variants of bla<sub>TEM</sub>, <em>tet</em>, <em>sul</em> genes were detected in most of the strains resistant to ampicillin, tetracycline and sulphonamide, respectively. The presence of class 1 integron was studied in 29 sulphonamide-resistant <em>E. coli</em> strains from which 15 harboured class 1 integron with four different arrangements of gene cassettes, <em>dfrA17</em>+<em>aadA5</em> (n=9), <em>dfrA1</em> + <em>aadA1</em> (n=4), <em>dfrA12</em> + <em>addA2</em> (n=1), <em>dfrA12</em>+<em>orf</em>+<em>addA2</em> (n=1). The <em>qnrB</em> gene was detected in six strains out of 13 quinolone-resistant <em>E. coli</em> strains. Seventeen <em>E. coli</em> isolates from diarrhoeic rabbits harboured the enteropathogenic eae genes associated with different virulence genes tested (<em>fimA</em>, <em>cnf1</em>, <em>aer</em>), and affiliated to B2 (n=8) and D (n=9) phylogroups. Isolated <em>E. coli</em> strains from healthy rabbit were harbouring <em>fim A</em> and/or <em>cnf1</em> genes and affiliated to A and B1 phylogroups. This study showed that <em>E. coli</em> strains from the intestinal tract of rabbits are resistant to the widely prescribed antibiotics in medicine. Therefore, they constitute a reservoir of antimicrobial-resistant genes, which may play a significant role in the spread of antimicrobial resistance. In addition, the eae virulence gene seemed to be implicated in diarrhoea in breeder rabbits in Tunisia.

scholarly journals Detection of virulence genes and antimicrobial resistance profiles of Escherichia coli isolates from raw milk and artisanal cheese in Southern Brazil

2019 ◽  
Vol 40 (1) ◽  
pp. 163 ◽  
Author(s):  
Leandro Parussolo ◽  
Ricardo Antônio Pilegi Sfaciotte ◽  
Karine Andrezza Dalmina ◽  
Fernanda Danielle Melo ◽  
Ubirajara Maciel Costa ◽  
...  
Keyword(s):  
Public Health ◽  
Escherichia Coli ◽  
Antimicrobial Susceptibility ◽  
Virulence Genes ◽  
Antimicrobial Agents ◽  
Raw Milk ◽  
Diffusion Method ◽  
Public Health Issue ◽  
Southern Brazil ◽  
E Coli

The serrano artisanal cheese is a typical product from South region of Brazil, which is produced by skilled cheesemakers using raw milk. The contamination of this food by Escherichia coli has a great impact on public health, since it could threat the consumers’ health. The study evaluated the presence of virulence genes, antimicrobial susceptibility profiles and bofilm-production ability of Escherichia coli isolates obtained from raw milk and artisanal cheese produced in Southern Brazil. A total of 117 isolates of E. coli were characterized by multiplex PCR to detect the following virulence genes: eae for enteropatogenic E. coli (EPEC), lt and st for enterotoxigenic E. coli (ETEC), stx for shiga toxin-producing E. coli (STEC), stx and eae for enterohemorrhagic E. coli (EHEC), ipaH for enteroinvasive E. coli (EIEC) and aggR for enteroaggregative E. coli (EAEC). In addition, antimicrobial susceptibility profile to 22 antimicrobial agents was also performed by disk diffusion method, and we searched for extended-spectrum beta-lactamases (ESBL) and/or carbapenemase- producing isolates. Isolates that were positive for ESBL and carbapenemase were further investigated for the presence of the genes: blaTEM, blaSHV, blaOXA, blaCTX-M, for ESBL and blaOXA-48 for carbapenemase. Further, isolates had their ability to form biofilms investigated by the red Congo agar method. Virulence genes of E. coli were identified in 21.37% of the tested isolates, which were classified as EPEC (the most prevalent pathotype) and ETEC or EAEC. Ten (8.55%) of the total studied E. coli isolates revealed a multidrug-resistant profile, since they were resistant to three or more antimicrobial classes; whereas four isolates (3.42%) were classified as ESBL-producers and showed the presence of blaTEM gene. None of the isolates exhibited carbapenemase activity nor did they carry carbapenemase genes. From the total of E. coli isolates, 79 (67.52%) were considered potential biofilm producers. These results address a serious public health issue, since artisanal cheeses pose a risk to consumers’ health, since may be sources of dissemination of diarrheogenic E. coli, that can cause from subclinical to severe and fatal infections in children and adults, and also emphasize the need to improve adaptations/adjustments in the manufacturing processes of these products.

Virulence factors analysis and antibiotic resistance of uropathogenic Escherichia coli isolated from patients in northeast of Iran

2020 ◽  
Author(s):  
Mahdis Ghavidel ◽  
Tahere Gholamhosseini-Moghadam ◽  
Kimiya Nourian ◽  
Kiarash Ghazvini
Keyword(s):  
Escherichia Coli ◽  
Antibiotic Resistance ◽  
Virulence Genes ◽  
High Rate ◽  
Resistance Pattern ◽  
Antibiotics Resistance ◽  
Disk Diffusion Test ◽  
E Coli ◽  
Genes Encoding ◽  
Tract Infections

Background and Objectives: Escherichia coli is known to be the pathogen commonly isolated from those infected with uri- nary tract infections (UTIs). The aim of this study was to investigate the presence of E. coli virulence genes and antibiotics’ resistance pattern among clinical isolates in the Northeast of Iran. Relationships between virulence genes and antimicrobial resistances were studied as well. Materials and Methods: Three hundred isolates of E. coli were isolated from patients with UTIs that referred to Ghaem and Imam Reza hospitals (Mashhad, Iran) during August 2016 to February 2017. A multiplex PCR was employed to amplify the genes encoding pyelonephritis associated pili (pap), S-family adhesions (sfa), type1fimbriae (fimH) and aerobactin (aer). Disk diffusion test was performed to test the susceptibility of isolates to β-lactams, aminoglycosides, cephalosporins, quino- lone, fluoroquinolones, carbapenems and trimethoprim-sulfamethoxazole. Results: The PCR results identified the fimH in 78.4%, aer in 70.5%, sfa in 13.6% and the pap in 8.2% of isolates. The rates of antibiotic resistance of the isolates were as follows: 64.7% resistant to cephalosporins, 34% to trimethoprim-sul- famethoxazole, 31% to fluoroquinolones, 15.3% to aminoglycosides, 13.3% to β-lactams, 7.8% to quinolones and 4.4% to carbapenems. Significant relationships existed between pap and aer, pap and sfa, aer and fluoroquinolones also pap and cephalosporins. Conclusion: fimH and aer were found in > 50% of isolates suggesting the importance of both genes in UPEC. The majority of isolates had fimH as adhesion factor for colonization. Determining antibiotic resistance patterns in specific geographical areas is necessary for appropriate treatment of urinary tract infection. The high rate of resistance to cephalosporins is most likely due to incorrect drug administration

scholarly journals Antibiotic resistance and virulence genes of extraintestinal pathogenic Escherichia coli from tropical estuary, south India

2015 ◽  
Vol 9 (05) ◽  
pp. 496-504 ◽  
Author(s):  
Divya Sukumaran ◽  
Abdulla A Mohamed Hatha
Keyword(s):  
Escherichia Coli ◽  
Antibiotic Resistance ◽  
Multidrug Resistance ◽  
Virulence Factor ◽  
Virulence Genes ◽  
Antimicrobial Agents ◽  
Diffusion Method ◽  
Disk Diffusion Method ◽  
E Coli ◽  
Virulence Factor Genes

Introduction: Escherichia coli strains can cause a variety of intestinal and extraintestinal diseases. Extraintestinal pathogenic E. coli (ExPEC) strains have the ability to cause severe extraintestinal infections. Multidrug resistance among ExPEC could complicate human infections. Methodology: Escherichia coli strains were isolated during the period of January 2010 to December 2012 from five different stations set at Cochin estuary. Susceptibility testing was determined by the disk-diffusion method using nine different antimicrobial agents. A total of 155 strains of Escherichia coli were screened for the presence of virulence factor genes including papAH, papC, sfa/focDE, iutA,and kpsMT II associated with ExPEC. Results: Among the 155 E. coli isolates, 26 (16.77%), carried two or more virulence genes typical of ExPEC. Furthermore, 19.23% of the ExPEC isolates with multidrug resistance were identified to belong to phylogenetic groups B2 and D. Statistically significant association of iutA gene in ExPEC was found with papC (p < 0.001) and kpsMT II (p < 0.001) genes. ExPEC isolates were mainly resistant to ampicillin (23.07%), tetracycline (19.23%), co-trimoxazole (15.38%), and cefotaxime (15.38%). The adhesion genes papAH and sfa/focDE were positively associated with resistance to gentamicin, chloramphenicol, and cefotaxime (p < 0.05). Conclusions: Co-occurrence of virulence factor genes with antibiotic resistance among ExPEC poses considerable threat to those who use this aquatic system for a living and for recreation.

scholarly journals Characterization of auto-agglutinating and non-typeable uropathogenic Escherichia coli strains

2019 ◽  
Vol 13 (06) ◽  
pp. 465-472
Author(s):  
Ulises Hernández-Chiñas ◽  
Alejandro Pérez-Ramos ◽  
Laura Belmont-Monroy ◽  
María E Chávez-Berrocal ◽  
Edgar González-Villalobos ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Virulence Genes ◽  
Antimicrobial Agents ◽  
Multidrug Resistant ◽  
Uropathogenic Escherichia Coli ◽  
E Coli ◽  
Resistant Strains ◽  
Tract Infections ◽  
Disk Method

Introduction: Uropathogenic Escherichia coli (UPEC) are the main etiological agent of urinary tract infections (UTIs). Association between different serotypes and UTIs is known, however, some strains are incapable to be serotyped. The aim of this work was to study bthe phenotypical and genotypical characteristics of 113 non-typeable (NT) and auto-agglutinating (AA) E. coli strains, isolated from UTIs in children and adults. Methodology: The 113 UPEC strains were analyzed by PCR assays using specific primers to determine their serogroups, fimH, papC, iutA, sat, hlyCA and cnf1, virulence associated genes, and chuA, yjaA and TSPE4.C2 for phylogroup determination. Additionally, the diffusion disk method was performed to evaluate the antimicrobial resistance to 18 antimicrobial agents. Results: Using the PCR assay, 63% (71) of the strains were genotyped showing O25 and O75 as the most common serogroups. The virulence genes fimH (86%) and iutA (74%) were the most prevalent, in relation to the phylogroups the commensal (A and B1) and virulent (B2 and D) showed similar frequencies (P > 0.05). The antimicrobial susceptibility test showed a high percentage (73%) of multidrug-resistant strains. Conclusions: The genotyping allowed identifying the serogroup in many of the strains that could not be typed by traditional serology. The strains carried virulence genes and were multidrug-resistant in both, commensal and virulent phylogroups. Our findings revealed that, in addition to the classical UPEC serogroups, there are pathogenic serogroups not reported yet.

Phylogenetic genotyping, virulence genes and antimicrobial susceptibility of Escherichia coli isolates from cases of bovine mastitis

2021 ◽  
Vol 88 (1) ◽  
pp. 78-79
Author(s):  
Nashmil Aslam ◽  
Saeed-Ul-Hassan Khan ◽  
Tahir Usman ◽  
Tariq Ali
Keyword(s):  
Escherichia Coli ◽  
Antimicrobial Susceptibility ◽  
Iron Uptake ◽  
Virulence Genes ◽  
Bovine Mastitis ◽  
Virulence Gene ◽  
E Coli ◽  
Milk Samples ◽  
Group A ◽  
Mastitic Milk

AbstractThe study described in this research communication used phylogenetic genotyping to identify virulence genes and antimicrobial susceptibility in Escherichia coli recovered from cases of bovine mastitis. From 385 mastitic milk samples, 30 (7.8%) isolates were confirmed as E. coli. Most isolates (80%) belonged to phylo-group A. These 30 E. coli isolates were also screened for 11 different virulence genes. The majority of isolates (63%) harbored no virulence gene. Only 11 (37%) isolates tested positive for two virulence genes, either the iron uptake gene iucD in 3 (10%) isolates or the serum resistance gene traT in 2 (7%) isolates or both traT and iucD in 6 (20%) isolates. The E. coli isolates showed highest susceptibility to gentamicin, meropenem, and pipracillin. Most isolates were resistant to ampicillin, cefotaxime and streptomycin. This study suggests that mastitis causing E. coli might originate from commensal bacteria and that the presence of these virulence genes, common in extra-intestinal pathogenic E. coli (ExPEC) strains could be attributed to high genetic variability of mastitis-causing E. coli.

scholarly journals The causal relationship between O2:K7:H6 extra-intestinal pathogenic Escherichia coli (ExPEC) and native valve endocarditis: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Marie-Françoise Leonard ◽  
Hector Rodriguez-Villalobos ◽  
Nadia Boisen ◽  
Flemming Scheutz ◽  
Pierre-François Laterre ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Virulence Genes ◽  
Native Valve ◽  
Case Presentation ◽  
E Coli ◽  
Native Valve Endocarditis ◽  
Post Operative Period ◽  
Pathogenic Escherichia Coli ◽  
Ureteral Lithiasis ◽  
The Relationship

Abstract Background Native valves infective endocarditis due to Escherichia coli is still a rare disease and a particular virulence of some E.coli isolate may be suspected. Case presentation A 79-year-old woman presented during the post-operative period of an orthopedic surgery a urinary tract infection following obstructive ureteral lithiasis. E. coli was isolated from a pure culture of urine and blood sampled simultaneously. After evidence of sustained E.coli septicemia, further investigations revealed acute cholecystitis with the same micro-organism in biliary drainage and a native valve mitral endocarditis. E.coli was identified as O2:K7:H6, phylogenetic group B2, ST141, and presented several putative and proven virulence genes. The present isolate can be classified as both extra-intestinal pathogenic E.coli (ExPECJJ) and uropathogenic E. coli (UPECHM). Conclusions The relationship between the virulent factors present in ExPEC strains and some serotypes of E. coli that could facilitate the adherence to cardiac valves warrants further investigation.

scholarly journals Antimicrobial Resistance and Virulence Genes of Escherichia coli Isolates from Swine in Ontario

2005 ◽  
Vol 71 (11) ◽  
pp. 6753-6761 ◽  
Author(s):  
Patrick Boerlin ◽  
Rebeccah Travis ◽  
Carlton L. Gyles ◽  
Richard Reid-Smith ◽  
Nicol Janecko Heather Lim ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Antimicrobial Resistance ◽  
Resistance Genes ◽  
Virulence Genes ◽  
Antimicrobial Agents ◽  
Negative Association ◽  
Bacterial Populations ◽  
E Coli ◽  
Strong Negative Association ◽  
First Time

ABSTRACT A total of 318 Escherichia coli isolates obtained from diarrheic and healthy pigs in Ontario from 2001 to 2003 were examined for their susceptibility to 19 antimicrobial agents. They were tested by PCR for the presence of resistance genes for tetracycline, streptomycin, sulfonamides, and apramycin and of 12 common virulence genes of porcine E. coli. Antimicrobial resistance frequency among E. coli isolates from swine in Ontario was moderate in comparison with other countries and was higher in isolates from pigs with diarrhea than in isolates from healthy finisher pigs. Resistance profiles suggest that cephamycinases may be produced by ≥8% of enterotoxigenic E. coli (ETEC). Resistance to quinolones was detected only in enterotoxigenic E. coli (≤3%). The presence of sul3 was demonstrated for the first time in Canada in porcine E. coli isolates. Associations were observed among tetA, sul1, aadA, and aac(3)IV and among tetB, sul2, and strA/strB, with a strong negative association between tetA and tetB. The paa and sepA genes were detected in 92% of porcine ETEC, and strong statistical associations due to colocation on a large plasmid were observed between tetA, estA, paa, and sepA. Due at least in part to gene linkages, the distribution of resistance genes was very different between ETEC isolates and other porcine E. coli isolates. This demonstrates that antimicrobial resistance epidemiology differs significantly between pathogenic and commensal E. coli isolates. These results may have important implications with regards to the spread and persistence of resistance and virulence genes in bacterial populations and to the prudent use of antimicrobial agents.

scholarly journals Molecular Study of E. coli Virulence Genes in Nosocomial Sepsis

2019 ◽  
Vol 16 (2) ◽  
pp. 269-277
Author(s):  
Maysaa E. Zaki ◽  
Samah Bastawy ◽  
Karim Montasser
Keyword(s):  
Medical Devices ◽  
Virulence Genes ◽  
Carbapenem Resistance ◽  
Diffusion Method ◽  
Antibiotics Resistance ◽  
Gene Encoding ◽  
Cross Sectional ◽  
E Coli ◽  
Nosocomial Sepsis ◽  
Extended Spectrum

Escherichia coli (E. coli) is a common cause of nosocomial sepsis. There are multiple factors related to the severity of sepsis among these are the presence of virulence genes and the pattern of antibiotics resistance. The aim of the present study was to determine the prevalence of virulence pap gene encoding for pili, hlyA gene encoding for α-hemolysin and cnf1 gene encoding for cytotoxic necrotizing factor 1 among E. coli isolated from children with nosocomial sepsis. Also, to correlate the presence of ESBL and carbapenem resistance with the presence of these genes. The study is a retrospective cross-sectional study included 150 non-duplicate strains of E. coli isolated from blood cultures from children with nosocomial sepsis. The isolated E. coli strains were subjected to antibiotics study by disc diffusion method, detection of extended spectrum lactamase production by double discs diffusion method and determination of resistance to carbapenem by combined tests methods. The detection of virulence genes pap, hylA and cnf-1 were determined by multiplex polymerase chain reaction (PCR). E. coli isolates were classified as ESBL phenotype in 56% of the isolates and carbapenemase producing phenotype in 34.7%. Pap gene, hylA and cnf-1 genes were detected in 30%, 23.3% and 22.7% of the isolated E. coli. The clinic-laboratory study of the virulence genes of E. coli revealed the significant association of pap, hylA and cnf-1genes with prolonged duration of the use of the medical devices (4.3± 2.9 days-P=0.01, 4.5± 2.9 days, P=0.02, 5.2± 3.4 days, P=0.0001 respectively). HylA gene was associated with younger age of the patients (28.4± 4.5, P=0.01). Pap gene was significantly associated with ESBLs and carbapenemase phenotypes (P=0.0001, P=0.002 respectively). On the other hand, cnf-1 was significantly associated with E. coli isolated from primary sepsis (P=0.02) and in isolates from sepsis due to medical devices (P=0.02) and was significantly associated with death (P=0.01) and carbapenemase resistance (P=0.01). The present study highlights the prevalence of pap, hylA and cnf-1 virulence genes among E. coli associated with nosocomial sepsis in children. The frequency of some of these genes was correlated with extended spectrum lactamase resistance and carbapenemase resistance. This may be attributed to the presence of the virulence and antibiotics genes on transferable plasmids. Moreover, there was association with cnf-1 virulence gene and mortality outcome of sepsis. Further studies are recommended to evaluate these findings.

scholarly journals Characterization of Clinical Escherichia coli Strains Producing a Novel Shiga Toxin 2 Subtype in Sweden and Denmark

2021 ◽  
Vol 9 (11) ◽  
pp. 2374
Author(s):  
Xiangning Bai ◽  
Flemming Scheutz ◽  
Henrik Mellström Dahlgren ◽  
Ingela Hedenström ◽  
Cecilia Jernberg
Keyword(s):  
Escherichia Coli ◽  
Shiga Toxin ◽  
Virulence Genes ◽  
Epidemiological Surveillance ◽  
E Coli ◽  
Shiga Toxin 2 ◽  
Life Threatening ◽  
Macrolide Resistance Gene

Shiga toxin (Stx) is the key virulence factor in the Shiga Toxin-Producing Escherichia coli (STEC), which can cause diarrhea and hemorrhagic colitis with potential life-threatening complications. There are two major types of Stx: Stx1 and Stx2. Several Stx1/Stx2 subtypes have been identified in E. coli, varying in sequences, toxicity and host specificity. Here, we report a novel Stx2 subtype (designated Stx2m) from three clinical E. coli strains isolated from diarrheal patients and asymptomatic carriers in Sweden and Denmark. The Stx2m toxin was functional and exhibited cytotoxicity in vitro. The two Swedish Stx2m-producing strains belonged to the same serotype O148:H39 and Multilocus Sequencing Typing (MLST) Sequence Type (ST) 5825, while the Danish strain belonged to the O96:H19 serotype and ST99 type. Whole-genome sequencing (WGS) data analysis revealed that the three Stx2m-producing strains harbored additional virulence genes and the macrolide resistance gene mdf (A). Our findings expand the pool of Stx2 subtypes and highlight the clinical significance of emerging STEC variants. Given the clinical relevance of the Stx2m-producing strains, we propose to include Stx2m in epidemiological surveillance of STEC infections and clinical diagnosis.

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