**4. Global antibiotics resistance in** *E. coli*

As earlier described, *E. coli* is one of the important bacteria, causing infections in the gastrointestinal tract [73]. Worldwide, AMRs in *E. coli* have been reported which show significant geographic variation as well as differences in various populations and environments. The evolving of ESBL and fluoroquinolones resistance and lack of availability of effective treatment in infections in *E. coli* strains spread over the last few years. However, if *E. coli* resistance is not tackle will restrict out treatment strategies, and resistant clones spread in the general population [74].

#### **4.1 Emergence of** *E. coli* **resistance in Europe**

In European countries, particularly in *E. coli* AMRs are increasing [75, 76]. AMR is a worldwide threat, with an approximately 25,000 deaths occurring in Europe and 23,000 in the United States each year [77]. Due to MDR strains treatment becomes complicated and there are more chances of its spread. In addition,

### *Antimicrobial Resistance in* Escherichia coli *DOI: http://dx.doi.org/10.5772/intechopen.101583*

particularly *E. coli* is mostly involved in community and hospital-acquired infections [78, 79]. The severity of the disease differs considerably depending upon the *E. coli* strains [80]. Considering the case of Europe, faced two epidemics of the hemolytic uremic syndrome (HUS) and bloody diarrhea between May and July 2011. One major epidemic occurred in Germany (almost 4000 cases of bloody diarrhea, 850 of HUS, and 50 death cases were reported), while few cases were reported in southwest France (15 cases of bloody diarrhea and 9 cases of HUS) [81–83]. Commonly, these outbreaks were caused by a strain of Stx producing *E. coli* [84] which possesses a plasmid encoding ESBL [83]. The ratio of *E.coli* O104-H4 infected patients with complications such as HUS are more prevalent than in earlier epidemics [85]. AMRs *E. coli* strains are observed all around Europe. According to the European center for disease prevention and control (ECDC), the resistance in human sources varies significantly between countries [86]. Though, in each country mostly the prevalence of *E. coli* strains were observed resistant to all antibiotic classes such as 3rd generation cephalosporins, fluoroquinolones, and aminoglycosides. The ratio of isolates resistant to cephalosporins was observed highest in Cyprus (36.2%), Slovakia (31%), and Bulgaria (22.9%) and lowest in Sweden (3.0%) and Norway (3.6%) respectively. While less resistant were found against fluoroquinolones in Sweden (7.9%) and Estonia (9.9%) but fluoroquinolones resistance is more prevalent in Cyprus (47.4%) and Italy (40.5%) and furthermore high prevalence rate of isolates resistant to aminoglycosides were observed in the United States (23.9%), Romania (19.6%), Slovakia (17.9%) and Greece (16.8%), Sweden (3.7%). *E. coli* strains resistant to widespread Penicillin were found in 28 countries. Besides this, 0.04% of *E. coli* strains were observed to be resistant to carbapenems. In Europe, according to a current study resistance due to carbapenemases producing are still circulating [87].
