{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T15:25:51Z","timestamp":1784042751759,"version":"3.55.0"},"reference-count":25,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2022,11,16]],"date-time":"2022-11-16T00:00:00Z","timestamp":1668556800000},"content-version":"vor","delay-in-days":319,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Cukurova University Scientific Research Projects","award":["TDK-2015-3303"],"award-info":[{"award-number":["TDK-2015-3303"]}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["International Journal of Clinical Practice"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:p><jats:italic>Backgrounds<\/jats:italic>. Diagnostic markers of extraintestinal infection in <jats:italic>Escherichia coli<\/jats:italic> (<jats:italic>E. coli<\/jats:italic>) remain unclear in the literature. Extraintestinal pathogenic <jats:italic>E. coli<\/jats:italic> (ExPEC) is differentiated from other <jats:italic>E. coli<\/jats:italic> isolates in terms of virulence factors, such as host cell adhesion, invasion, cytotoxic necrotizing factor (<jats:italic>CNF<\/jats:italic> (<jats:italic>cnf1-cnf3<\/jats:italic>)) and cytolethal distending toxin (<jats:italic>CDT<\/jats:italic> (<jats:italic>cdt1-cdt4<\/jats:italic>) that are responsible for cell death. We aimed to investigate the frequency of <jats:italic>CNF-CDT<\/jats:italic> and the relationship between the clinical diagnosis and genotypes in <jats:italic>E. coli<\/jats:italic> isolates with different clinical origins. <jats:italic>Methods<\/jats:italic>. A total of 646 <jats:italic>E. coli<\/jats:italic> isolates (obtained from 645 patients) isolated from different infection sites other than the intestine were evaluated in aspects of the <jats:italic>CNF<\/jats:italic>, <jats:italic>CDT<\/jats:italic> virulence genes, phylogenetic grouping, and phylogenetic relationship by using PCR and PFGE. <jats:italic>Results<\/jats:italic>. At least one virulence gene was present in 156 (24%) of the 646 ExPEC isolates. We detected <jats:italic>cnf1<\/jats:italic>, <jats:italic>cnf2<\/jats:italic>, and <jats:italic>cnf3<\/jats:italic>, in 78, 12, and 20 ExPEC isolates, respectively. Also, <jats:italic>cdt1<\/jats:italic>, <jats:italic>cdt2<\/jats:italic>, <jats:italic>cdt3<\/jats:italic>, and <jats:italic>cdt4<\/jats:italic> genes were present in 20, 4, 4, and 4 isolates, respectively. Some isolates harbored more than one gene, being <jats:italic>cnf1<\/jats:italic>\u2010<jats:italic>cnf3<\/jats:italic> (<jats:italic>n<\/jats:italic>\u2009=\u20096), <jats:italic>cnf1<\/jats:italic>\u2010<jats:italic>cdt1<\/jats:italic> (<jats:italic>n<\/jats:italic>\u2009=\u20094), and <jats:italic>cdt1<\/jats:italic>\u2010<jats:italic>cdt4<\/jats:italic> (<jats:italic>n<\/jats:italic>\u2009=\u20094). These 156 isolates were distributed into 106 large clusters by PFGE. Virulent ExPEC is primarily related to groups <jats:italic>B<\/jats:italic>2 (60%) and <jats:italic>D<\/jats:italic> (32%). <jats:italic>Conclusion<\/jats:italic>. To our knowledge, this study demonstrated the presence of <jats:italic>cnf2, cnf3, cdt1, cdt2, cdt3<\/jats:italic>, and <jats:italic>cdt4<\/jats:italic> genes for the first time in the literature for Turkey. The widespread presence of the CNF gene in <jats:italic>E. coli<\/jats:italic> helps distinguish ExPEC from commensal isolates.<\/jats:p>","DOI":"10.1155\/2022\/7200635","type":"journal-article","created":{"date-parts":[[2022,11,16]],"date-time":"2022-11-16T09:05:19Z","timestamp":1668589519000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["The Distribution of Cytotoxic Necrotizing Factors (CNF\u20101, CNF\u20102, CNF\u20103) and Cytolethal Distending Toxins (CDT\u20101, CDT\u20102, CDT\u20103, CDT\u20104) in <i>Escherichia coli<\/i> Isolates Isolated from Extraintestinal Infections and the Determination of their Phylogenetic Relationship by PFGE"],"prefix":"10.1155","volume":"2022","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6112-0693","authenticated-orcid":false,"given":"Cansu","family":"Onlen Guneri","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0790-1525","authenticated-orcid":false,"given":"Fatih","family":"Koksal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1039-8556","authenticated-orcid":false,"given":"Suna","family":"Kizilyildirim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2207-6631","authenticated-orcid":false,"given":"Basak","family":"Bedir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5719-370X","authenticated-orcid":false,"given":"Togrul","family":"Nagiyev","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,11,16]]},"reference":[{"key":"e_1_2_13_1_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrmicro818"},{"key":"e_1_2_13_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.yexmp.2008.03.007"},{"key":"e_1_2_13_3_2","doi-asserted-by":"publisher","DOI":"10.1126\/science.1127059"},{"key":"e_1_2_13_4_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2958.1997.4181785.x"},{"key":"e_1_2_13_5_2","doi-asserted-by":"publisher","DOI":"10.1126\/science.1086802"},{"key":"e_1_2_13_6_2","doi-asserted-by":"publisher","DOI":"10.4081\/mm.2016.6324"},{"key":"e_1_2_13_7_2","article-title":"Using of astA and uidA genes characterization in detection of Escherichia coli prevalence from human gallstone","volume":"3","author":"Abid J.","year":"2014","journal-title":"International Journal of Science and Research (IJSR)"},{"key":"e_1_2_13_8_2","doi-asserted-by":"publisher","DOI":"10.1128\/jcm.02365-09"},{"key":"e_1_2_13_9_2","doi-asserted-by":"publisher","DOI":"10.1128\/jcm.41.9.4285-4291.2003"},{"key":"e_1_2_13_10_2","doi-asserted-by":"publisher","DOI":"10.1128\/aem.66.10.4555-4558.2000"},{"key":"e_1_2_13_11_2","first-page":"157","article-title":"The outbreak of acinetobacter baumannii producing OXA-23 and OXA-51 type carbapenemases in a state hospital","volume":"33","author":"Gokmen T.","year":"2016","journal-title":"Journal of Experimental and Clinical Medicine"},{"key":"e_1_2_13_12_2","doi-asserted-by":"publisher","DOI":"10.4172\/2327-5073.1000171"},{"key":"e_1_2_13_13_2","doi-asserted-by":"publisher","DOI":"10.1155\/2014\/959206"},{"key":"e_1_2_13_14_2","doi-asserted-by":"publisher","DOI":"10.1128\/iai.62.1.244-251.1994"},{"key":"e_1_2_13_15_2","doi-asserted-by":"publisher","DOI":"10.1128\/iai.00962-08"},{"key":"e_1_2_13_16_2","first-page":"97","article-title":"Detection and characterization of necrotoxin producing Escherichia coli (NTEC) from calves with diarrhoea","volume":"10","author":"Rahman H.","year":"2012","journal-title":"JVPH"},{"key":"e_1_2_13_17_2","doi-asserted-by":"publisher","DOI":"10.1155\/2014\/465054"},{"key":"e_1_2_13_18_2","doi-asserted-by":"publisher","DOI":"10.1590\/s0100-879x2008001000008"},{"key":"e_1_2_13_19_2","doi-asserted-by":"publisher","DOI":"10.1017\/s0950268807009247"},{"key":"e_1_2_13_20_2","doi-asserted-by":"publisher","DOI":"10.7717\/peerj.5470"},{"key":"e_1_2_13_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.fm.2005.07.003"},{"key":"e_1_2_13_22_2","doi-asserted-by":"publisher","DOI":"10.3906\/sag-1507-114"},{"key":"e_1_2_13_23_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0463.2008.00910.x"},{"key":"e_1_2_13_24_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2180-9-132"},{"key":"e_1_2_13_25_2","doi-asserted-by":"publisher","DOI":"10.1128\/iai.62.1.244-251.1994"}],"container-title":["International Journal of Clinical Practice"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/downloads.hindawi.com\/journals\/ijclp\/2022\/7200635.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/downloads.hindawi.com\/journals\/ijclp\/2022\/7200635.xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/2022\/7200635","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T08:58:18Z","timestamp":1757581098000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1155\/2022\/7200635"}},"subtitle":[],"editor":[{"given":"Ertugurul","family":"Ercan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,1]]},"references-count":25,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2022,1]]}},"alternative-id":["10.1155\/2022\/7200635"],"URL":"https:\/\/doi.org\/10.1155\/2022\/7200635","archive":["Portico"],"relation":{},"ISSN":["1368-5031","1742-1241"],"issn-type":[{"value":"1368-5031","type":"print"},{"value":"1742-1241","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1]]},"assertion":[{"value":"2022-01-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-10-22","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-11-16","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"7200635"}}