**4. Epidemiology of resistance in** *E. coli*

The World Health Organization (WHO), through its Global Antimicrobial Surveillance System (GLASS) report, bared that there are treacherous levels of antibiotic resistance in both low- and high-income countries (LMIC) [38].

The European Centre for Disease Prevention and Control (ECDC) conveyed that 25,000 people died due to antibiotic-resistant bacterial infections in 2007, which is over half the number caused by road traffic accidents in the same countries [39]. In 2015, this number increased to about 33,000 deaths resulting from an estimated 671,689 infections of selected antibiotic-resistant bacteria leading to 874,541 total disability-adjusted life-years (DALYs) [40]. This indicates that the burden on the European Union and European Economic Area is on the rise. By 2050, the World Health Organization (WHO) predicted that, death because of antibiotic resistance would upsurge from 700,000 to 10 million per year globally [39]. As a result of antibiotic resistance, more than 2.8 million people are infected, and more than 35,000 die each year in the USA [41].

The estimated number of cases of uncomplicated cystitis per year, caused by *E. coli* alone, is 130–175 million globally and 2–300.000 in Denmark alone [42]. Consequently, infections caused by *E. coli*, susceptible and resistant, collectively result in considerable morbidity as well as direct and indirect financial costs seen as increased healthcare expenses, antibiotic treatment, and loss of productivity [43]**.**

Furthermore, UTI patients experience morbidity and impaired quality of life with an estimated 20–40% of women having at least one UTI during their lifetime [43]**.**

It is difficult to determine the precise incidence of UTI, but by using selfreported medical history the annual incidence in the USA was 13% among women and 3% among men [44]. Resistance in *E. coli*, besides β-lactam resistance, includes sulphonamides, trimethoprim, and ciprofloxacin [45].

In 2008, UPEC isolates from five countries, were commonly resistant to ampicillin 28%), sulfonamides (25%), trimethoprim (17%), and nalidixic acid (10%), with a significant increase in resistance to nalidixic acid and trimethoprim from 2000 to 2009. A total of 60%, only, of the UPEC isolates, were found to be fully susceptible [42]**.**

Antibiotic resistance continued to increase throughout Europe, with 41% being fully susceptible in 2012, only. Especially, the current increase in resistance to extended-spectrum cephalosporins mean = 12% and aminoglycosides (mean = 10%) in combination with increased resistance to at least three antibiotic classes, is worrisome. The increased resistance is likewise worrying in Denmark. In 2012, the resistance in *E. coli* isolated from urine (primary health care) was 40% for ampicillin with 33% for sulphonamide and 10% were resistant to ciprofloxacin and 6% to mecillinam [42, 46, 47]*.*

*DOI: http://dx.doi.org/10.5772/intechopen.104955* Escherichia coli *(*E. coli*) Resistance against Last Resort Antibiotics and Novel Approaches…*

The continual increase in resistant *E. coli* has added to the enormous economic and human costs of infections with 400.000 infections caused by MDR bacteria in Europe in 2007 [46]. The economic costs associated with these infections, counted as extra hospital costs and productivity losses exceeds €1.5 billion in Europe and \$20 billion per year in the United States [48, 49].
