Escherichia coli, EHEC, ETEC and EPEC

Escherichia coli is a facultative anaerobic, Gram-negative, acid-forming bacterium.

Escherichia coli bacteria are the most common pathogens of nosocomial infections. They can cause a variety of diseases, including:

  • Urinary tract infections

  • Intestinal infections

  • Prostatitis (inflammation of the prostate)

  • Cholecystitis (inflammation of the gall bladder)

  • Wound infections

  • Pneumonia

  • Meningitis in newborns

Escherichia coli is prevalent worldwide. Non-pathogenic Escherichia coli are commensals of the oral cavity and intestinal tract and skin.

There are also some pathogenic strains of Escherichia coli called:

  • EHEC - Enterohaemorrhagic Escherichia coli

  • ETEC - Enterotoxic Escherichia coli

  • EPEC - Enteropathogenic Escherichia coli

In contrast to the usual Escherichia coli bacteria, EHEC, ETEC and EPEC have special features such as adherence to the intestinal wall with the help of a specific envelope protein (adhesin), and/or they can form a toxin e.g., Shiga, Vero-Toxin.

As bacterial pathogens, EHEC bacteria cause, among other symptoms:

  • Gastroenteritis

  • Diarrhea

  • Enterohemorrhagic colitis

  • As a serious complication: hemolytic uremic syndrome (HUS)

ETEC bacteria cause, among other symptoms:

  • Watery diarrhea (becomes increasingly watery and bloody as the disease progresses)

  • Nausea

  • Increasing abdominal pain

  • Rarely fever and vomiting

  • Known as "travel sickness“

EPEC bacteria cause, among other symptoms:

  • Vomiting

  • Watery diarrhea

  • Reduced food intake (loss of appetite)

  • Patients have a fever and feel exhausted

  • Known as ”infant diarrhea“ in developing countries

Relevance of pathogen in transmission in endoscopy

  • Gastroenterology: Very high

  • Pulmonology: High

  • Ear, nose, and throat: Not relevant

  • Urology: Very high

Relevance for endoscope surveillance

  • High concern organism

Transmission route

The pathogen is transmitted by the fecal–oral route via contaminated food or water. Contact infections via animals such as cattle, goats, sheep, and pigs can also occur.

Resistance to antibiotics

Escherichia coli shows high rates of decreased antimicrobial susceptibility, including to beta-lactams, carbapenems, aminoglycosides, and tetracyclines, through to panresistance.

Sources and further readings

  1. Epstein L et al. New Delhi metallo-beta-lactamase-producing carbapenem-resistant Escherichia coli associated with exposure to duodenoscopes. JAMA 2014; 312: 1447–1455.

  2. Escherichia coli, Centers for Disease Control and Prevention, Accessed on 02.22.2021.

  3. Escherichia coli, Robert Koch-Institut, Accessed on 06.22.2021.

  4. Gries O, Ly T: Infektologie – Kompendium humanpathogener Infektionskrankheiten und Erreger, Springer-Verlag Berlin Heidelberg 2019.

  5. Ross AS et al. A quarantine process for the resolution of duodenoscope-associated transmission of multidrug-resistant Escherichia coli. Gastrointest Endosc 2015; 82:477–83.

  6. Enterotoxigenic E. coli (ETEC), Centers for Disease Control and Prevention, Accessed on 11.02.2023.

  7. EHEC-Erkrankung, RKI-Ratgeber, Robert Koch Institut, Accessed on 11.02.2023.