**4.2 Emergence of** *E. coli* **resistance in America**

In America, increased resistance of fluoroquinolones and cephalosporin in *E. coli* has been reported [88]. In most patients, *E. coli* ST-131 strains have been reported [89]. ST-131 *E. coli* clone is thought mainly involve in AMRs spreading. The most common clinical manifestation associated with *E. coli* is intraabdominal infection (IAIs). Overall, 26% of *E. coli* infections associated IAI in the Latin American region produced ESBLs compared to with all over the world [90]. Region-wise prevalence of ESBL producing *E. coli* within America varies as in Latin America it was higher in 2008 than earlier according to data being shared by the Study for Monitoring AMR trends (SMART). Many surveillance studies have presented that ESBL-producing bacteria are common in Latin America. According to Tigecycline Evaluation and Surveillance Trial (TEST) in Latin America, during the years 2004–2006, where total of 13.5% of *E. coli* isolates with ESBL phenotypes were identified [18]. According to the Meropenem Yearly Susceptibility Test Information Collection (MYSTIC) surveillance study performed in 1997 and 2003, South America had a higher ratio of ESBL producing *E. coli* than North America [91]. Similarly in Colombia in 2002 higher cases of ESBLs producers'strains were documented. Based on available data [21–22%], the percentage of *E. coli* isolates in Latin American was higher as compared to other developed countries of the world [88].
