| Summary: | Non-O157 serogroups contribute significantly to the burden of disease caused by Shiga toxin-producing <i>Escherichia coli</i> (STEC) and have been underrecognized by traditional detection algorithms. We described the epidemiology of non-O157 STEC in Alberta, Canada for the period of 2018 to 2021. All non-O157 STEC isolated from clinical samples were submitted for serotyping and qPCR targeting the <i>stx</i><sub>1</sub> and <i>stx</i><sub>2</sub> genes. A total of 729 isolates were identified. Increased detection occurred over the summer months, peaking in July. Patients 18 years and younger made up 42.4% of cases, with 31.1% in those 0–9 years of age. There was a slight female predominance (399/729, 54.7%) A total of 50 different serogroups were detected; the most common were O26 (30.3%), O103 (15.9%), O111 (12.8%), O121 (11.0%), O118 (3.3%) and O71 (2.9%). These six serogroups made up 76.2% of all isolates. In total, 567 (77.8%) were positive for <i>stx</i><sub>1</sub>, 114 (15.6%) were positive for <i>stx</i><sub>2</sub> and 48 (6.6%) were positive for both <i>stx</i><sub>1</sub> and <i>stx</i><sub>2</sub>. A wide variety of non-O157 serogroups have been detected in Alberta, with the most frequent serogroups differing from other locations. These results highlight the need for further characterization of their virulence factors and clinical impact.
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