Escherichia coli infections are being increasingly detected among poultry flocks, indicating the growing importance of this pathogen to the industry. The infection begins as a respiratory infection of the trachea, followed by colonization of the air sacs and lungs, from where it invades the blood-stream, leading to infection of the deeper organs (liver, heart, oviduct, and peritoneum). A number of factors play a crucial role in the virulence and pathogenesis of infection. The F1 and P pili are particularly important in establishing the infection at the level of the tracheal epithelium cell. Other important factors are aerobactin, capsule, and serum resistance. Treatment is with antibiotics, but the growing bacterial resistance of avian E. coli and stricter regulations mean that attention is turning to prophylactic, preventative, measures, such as vaccination. Current vaccines provide limited homologous protection against the pathogen. Research is needed to develop a good, broad-spectrum vaccine.