One hundred thirteen strains of Escherichia coli O44:H18 isolated in several countries over 25 years were examined for adhesion to tissue culture cells and for hybridization with DNA probes. Fifty-nine strains were from sporadic cases of infection; 54 were from 12 outbreaks. Of the 113 strains, 85 showed aggregative adhesion to HEp-2 cells; 36 were from sporadic cases and 49 were from 9 outbreaks. All adhesive strains hybridized with the probe for enteroaggregative E. coli (EAggEC) and 1 nonadhesive strain was also positive. However, 80 of the 86 EAggEC probe-positive strains also hybridized with the probe for diffusely adherent E. coli (DAEC) derived from the daaC gene of strain F1845. The EAggEC and DAEC probes hybridized to different fragments of a large plasmid in the O44:H18 strains.