Introduction. Shiga toxin-producing Escherichia coli (STEC) belong to a diverse group of gastrointestinal pathogens. The pathogenic potential of STEC is enhanced by the presence of the pathogenicity island called the Locus of Enterocyte Effacement (LEE), including the intimin encoding gene eae. Gap statement. STEC serotypes O128:H2 (Clonal Complex [CC]25), O91:H14 (CC33), and O146:H21 (CC442) are consistently in the top five STEC serotypes isolated from patients reporting gastrointestinal symptoms in England. However, they are eae/LEE-negative and perceived to be a low risk to public health, and we know little about their microbiology and epidemiology. Aim. We analysed clinical outcomes and genome sequencing data linked to patients infected with LEE-negative STEC belonging to CC25 (O128:H2, O21:H2), CC33 (O91:H14) and, and CC442 (O146:H21, O174:H21) in England to assess the risk to public health. Results. There was an almost ten-fold increase between 2014 and 2022 in the detection of all STEC belonging to CC25, CC33 and CC442 (2014 n=38, 2022 n=336), and a total of 1417 cases. There was a higher proportion of female cases (55–70 %) and more adults than children, with patients aged between 20–40 and >70 most at risk across the different serotypes. Symptoms were consistent across the three dominant serotypes O91:H14 (CC33), O146:H21 (CC442) and O128:H2 (CC25) (diarrhoea >75 %; bloody diarrhoea 25–32 %; abdominal pain 64–72 %; nausea 37–45 %; vomiting 10–24 %; and fever 27–30 %). Phylogenetic analyses revealed multiple events of acquisition and loss of different stx-encoding prophage. Additional putative virulence genes were identified including iha, agn43 and subA. Conclusions. Continued monitoring and surveillance of LEE-negative STEC infections is essential due to the increasing burden of infectious intestinal disease, and the risk that highly pathogenic strains may emerge following acquisition of the Shiga toxin subtypes associated with the most severe clinical outcomes.

中文翻译：

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2014-2022 年英国 LEE 阴性产志贺毒素大肠杆菌通报数量增加的临床和公共卫生影响

介绍。产生志贺毒素的大肠杆菌(STEC) 属于多种胃肠道病原体。 STEC 的致病潜力因称为肠细胞消失位点 (LEE) 的致病岛（包括 intimin 编码基因eae）的存在而增强。差距声明。 STEC 血清型 O128:H2（克隆复合体 [CC]25）、O91:H14 (CC33) 和 O146:H21 (CC442) 始终位于英国报告胃肠道症状的患者中分离出的前 5 名 STEC 血清型中。然而，它们是eae/ LEE 阴性的，被认为对公共健康的风险较低，而且我们对其微生物学和流行病学知之甚少。目的。我们分析了感染 LEE 阴性 STEC 的患者的临床结果和基因组测序数据，这些 STEC 属于 CC25 (O128:H2、O21:H2)、CC33 (O91:H14) 和 CC442 (O146:H21、O174:H21)。英国评估公共卫生风险。结果。 2014 年至 2022 年间，属于 CC25、CC33 和 CC442 的所有 STEC 的检测量几乎增加了 10 倍（2014 年n = 38，2022 年n = 336），总数为 1,417 例。女性病例比例较高（55-70%），成人病例多于儿童，在不同血清型中，年龄在 20-40 岁和 >70 岁之间的患者风险最高。三种主要血清型 O91:H14 (CC33)、O146:H21 (CC442) 和 O128:H2 (CC25) 的症状一致（腹泻 >75%；血性腹泻 25-32%；腹痛 64-72%；恶心 37 –45 %；呕吐 10–24 %；发烧 27–30 %）。系统发育分析揭示了不同 stx 编码原噬菌体的多个获得和丢失事件。还鉴定出其他假定的毒力基因，包括iha、agn43和subA。结论。由于传染性肠道疾病的负担日益增加，以及在获得与最严重的临床结果相关的志贺毒素亚型后可能出现高致病性菌株的风险，对 LEE 阴性 STEC 感染的持续监测和监测至关重要。