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Background  Knowledge about the distribution of  Escherichia Coli  ( E .  coli ) pathotypes in Iran is limited. This nation-wide survey aims to provide a comprehensive description of the distribution of five pathogenic  E .  coli  in Iran.    Methods  Stool samples were collected from 1,306 acute diarrhea cases from 15 provinces (2013–2014).  E .  coli -positive cultures underwent PCR testing for the detection of STEC, ETEC, EPEC, EAEC, and EIEC pathotypes. Pathotype frequency by province, age-group, and season was estimated.    Results  979 diarrhea samples (75.0%) were culture-positive for  E .  coli  (95% CI: 72.6, 77.3%), and 659 (50.5%) were pathogenic  E .  coli  (95% CI: 47.8, 53.2%). STEC was the most frequent pathotype (35.4%). ETEC (14.0%) and EPEC (13.1%) were the second and the third most frequent pathotypes, respectively. EAEC (4.3%) and EIEC (0.3%) were not highly prevalent. Fars (88.7%) and Khorasan-e-Razavi (34.8%) provinces had the highest and lowest frequencies, respectively.  E .  coli  pathotypes were more frequent in warmer than cooler seasons, showed the highest frequency among children under five years of age (73%), and had no significant association with participants’ gender.    Conclusions  Diarrheagenic  E .  coli  may be an important cause of acute diarrhea in adults and children in Iran. STEC and ETEC seem to be widespread in the country with a peak in warmer seasons, impacting the recommended use of seasonal STEC and ETEC vaccines, especially in high-risk groups. Monitoring the incidence of  E .  coli  pathotypes, serotypes, and antibiotic resistance over time is highly recommended for evaluation of interventions.

Frequency of five Escherichia Coli pathotypes in Iranian adults and children with acute diarrhea