e Urinary tract infections (UTIs) are among the most common infectious diseases of humans, with Escherichia coli responsible for >80% of all cases. One extreme of UTI is asymptomatic bacteriuria (ABU), which occurs as an asymptomatic carrier state that resembles commensalism. To understand the evolution and molecular mechanisms that underpin ABU, the genome of the ABU E. coli strain VR50 was sequenced. Analysis of the complete genome indicated that it most resembles E. coli K-12, with the addition of a 94-kb genomic island (GI-VR50-pheV), eight prophages, and multiple plasmids. GI-VR50-pheV has a mosaic structure and contains genes encoding a number of UTI-associated virulence factors, namely, Afa (afimbrial adhesin), two autotransporter proteins (Ag43 and Sat), and aerobactin. We demonstrated that the presence of this island in VR50 confers its ability to colonize the murine bladder, as a VR50 mutant with GI-VR50-pheV deleted was attenuated in a mouse model of UTI in vivo. We established that Afa is the island-encoded factor responsible for this phenotype using two independent deletion (Afa operon and AfaE adhesin) mutants. E. coli VR50afa and VR50afaE displayed significantly decreased ability to adhere to human bladder epithelial cells. In the mouse model of UTI, VR50afa and VR50afaE displayed reduced bladder colonization compared to wild-type VR50, similar to the colonization level of the GI-VR50-pheV mutant. Our study suggests that E. coli VR50 is a commensal-like strain that has acquired fitness factors that facilitate colonization of the human bladder. U rinary tract infections (UTIs) are among the most common infectious diseases of humans and a major cause of morbidity. It is estimated that 40 to 50% of all adult women experience at least one UTI episode in their lifetime (1). In addition to welldocumented symptomatic infections, many UTIs are asymptomatic. These infections, referred to as asymptomatic bacteriuria (ABU), represent a carrier state that resembles commensalism and occur in a percentage of the population, depending on age and gender. ABU patients may carry Ͼ10 5 CFU of a single bacterial strain/ml of urine for months or years without significant symptoms.Escherichia coli causes more than 80% of all symptomatic and asymptomatic UTIs. In general, strains that cause symptomatic UTI are collectively described as uropathogenic E. coli (UPEC), while strains that cause asymptomatic UTI are referred to as ABU E. coli. Both UPEC and ABU E. coli strains exhibit a high degree of genetic diversity that is largely attributed to the presence of virulence/fitness genes on mobile genetic elements referred to as pathogenicity islands (PAIs) or genomic islands (GIs) (2, 3). While no single virulence factor is uniquely definitive for UPEC or ABU E. coli, the ability to colonize the urinary tract is enhanced by a number of factors, including fimbriae (e.g., type 1, P, F1C, and Afa), autotransporter proteins (e.g., Ag43, UpaB, and UpaH), cell surface polysaccharides (e.g., O antigen), and siderophores (e.g., ente...