Extended-Spectrum Beta-Lactamase-Producing Escherichia coli in Healthcare Settings: Epidemiology, Risk Factors, Infection Control Strategies and Emerging Treatment Options

Antimicrobial resistance continues to threaten the effectiveness of modern antimicrobial therapy, with ESBL-producing Escherichia coli emerging as a major cause of difficult-to-treat healthcare-associated infections. The global spread of these organisms is driven by antimicrobial selection pressure, genetic adaptability and transmission across healthcare, community and environmental reservoirs. This narrative review aimed to synthesise current evidence on the epidemiology, risk factors, transmission pathways, infection prevention strategies, antimicrobial stewardship approaches and emerging therapeutic options for ESBL-producing E. coli in healthcare settings. A structured narrative review was conducted using literature published between 2016 and the search date (June 6, 2026) indexed in PubMed, ScienceDirect, Dimensions and Google Scholar as well as literature obtained through grey literature search and screening of reference lists.. Relevant studies, including epidemiological investigations, molecular studies, clinical research, systematic reviews, surveillance reports and treatment guidelines, were critically analysed through thematic synthesis. The review found that ESBL-producing E. coli has become a globally distributed antimicrobial-resistant pathogen, with healthcare populations experiencing substantial intestinal carriage and infection burden. It was found that prolonged hospitalisation, previous antibiotic exposure, invasive devices, diabetes, chronic wounds and increased healthcare contact significantly contribute to colonisation and clinical infection. Furthermore, transmission is sustained through interactions between patients, healthcare workers, medical devices and contaminated environments. Antimicrobial stewardship, genomic surveillance, infection prevention measures and emerging therapies such as β-lactamase inhibitors, bacteriophage therapy and microbiome-based interventions represent important strategies for future control. Overall, reducing the burden of ESBL-producing E. coli requires coordinated global action integrating surveillance, responsible antimicrobial use, infection prevention and innovation in therapeutic development.