Although extraintestinal pathogenic Escherichia coli (ExPEC) are designated by their isolation site and grouped based on the type of host and the disease they cause, most diarrheagenic E. coli (DEC) are subdivided into several pathotypes based on the presence of specific virulence traits directly related to disease development. This scenario of a well-categorized E. coli collapsed after the German outbreak of 2011, caused by one strain bearing the virulence factors of two different DEC pathotypes (enteroaggregative E. coli and Shiga toxin-producing E. coli). Since the outbreak, many studies have shown that this phenomenon is more frequent than previously realized. Therefore, the terms hybrid- and hetero-pathogenic E. coli have been coined to describe new combinations of virulence factors among the classic E. coli pathotypes. In this review, we provide an overview of these classifications and highlight the E. coli genomic plasticity that results in some mixed E. coli pathotypes displaying novel pathogenic strategies, which lead to a new symptomatology related to E. coli diseases. In addition, as the capacity for genome interrogation has grown in the last few years, it is clear that genes encoding some virulence factors, such as Shiga toxin, are found among different E. coli pathotypes to which they have not traditionally been associated, perhaps foreshowing their emergence in new and severe outbreaks caused by such hybrid strains. Therefore, further studies regarding hetero-pathogenic and hybrid-pathogenic E. coli isolates are necessary to better understand and control the spread of these pathogens.

虽然肠外致病 大肠杆菌 （ExPEC）由它们的隔离位点指定，并根据宿主的类型和它们引起的疾病进行分组，其中大多数是腹泻型 大肠杆菌（DEC）根据与疾病发展直接相关的特定毒力特性的存在，分为几种病态类型。这种情况的分类很好大肠杆菌 因一株带有两种不同DEC致病型的致病因子的菌株（肠道聚集性 大肠杆菌 和滋贺毒素生产 大肠杆菌）。自爆发以来，许多研究表明，这种现象比以前意识到的更为频繁。因此，术语混合病原体和异种病原体大肠杆菌 曾被用来描述经典中毒力因子的新组合 大肠杆菌病型。在这篇评论中，我们提供了这些分类的概述，并重点介绍了大肠杆菌 基因组可塑性导致一些混杂 大肠杆菌 表现出新的致病策略的致病型，导致与之相关的新症状 大肠杆菌疾病。此外，随着近几年来基因组询问能力的提高，很明显，在不同物种之间发现了编码某些毒力因子（例如志贺毒素）的基因大肠杆菌传统上与它们不相关的病理类型，也许预示了它们在由这种杂种菌株引起的新的严重暴发中的出现。因此，关于异病原和杂交病原的进一步研究大肠杆菌 分离株对于更好地了解和控制这些病原体的传播是必不可少的。