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Background   Escherichia coli  is one of the most common strains of extended-spectrum β-lactam (ESBL)-producing bacteria, and the prevention and treatment of ESBL-producing  E. coli  infections is an ongoing challenge. The clinical characteristics and outcomes of ESBL-producing  E. coli  bacteremia in non-transplant patients remain to be elucidated.    Methods  This retrospective study included 491 non-transplant patients with  E. coli  bloodstream infections (BSIs) from January 2013 to December 2016 and was conducted to investigate the risk factors, clinical features, and outcomes of these infections.    Results  Of the 491  E. coli  BSI patients, 57.6% suffered from infections with ESBL-producing strains. A multivariate analysis showed that urinary tract infection, prior use of cephalosporin, and treatment with β-lactam-β-lactamase inhibitor (BLBLI) combination antibiotics were independent risk factors for the development of ESBL-producing  E. coli  BSIs. The overall mortality rate in  E. coli  BSI patients was 14.46%, and there was no significant difference in the 28 day mortality rate between ESBL-producing  E. coli  and non-ESBL-producing  E. coli  BSI patients (14.8% vs. 14.0%, respectively;  P  = 0.953). Similarly, there was no difference between the community-acquired infection group and the nosocomial infection group. Hepatobiliary disease, carbapenem exposure, high APACHE II score, and hypoproteinemia were independent risk factors for death in  E. coli  BSI patients. Multivariate analysis showed that hypoproteinemia and severe disease were independent risk factors for death from  ESBL -producing  E. coli  BSIs. Furthermore, there was no significant difference in the 28 day mortality between patients with  ESBL -producing  E. coli  BSIs treated with carbapenem monotherapy versus those treated with BLBLI combination antibiotics (12.8% vs. 17.9%, respectively;  P  = 0.384).    Conclusions  Prior use of cephalosporin or BLBLI combination antibiotics increased the risk ratio for  ESBL -producing  E. coli  infection. Hypoproteinemia and severe disease are independent risk factors for death in patients with  E. coli  BSIs. There was no significant difference in the 28 day prognosis of patients with ESBL-producing  E. coli  and those with non-ESBL-producing  E. coli  BSIs. These data do not support the conclusion that carbapenems might be more effective than BLBLI antibiotics for treatment of patients with BSIs caused by ESBL-producing  E. coli .    Electronic supplementary material  The online version of this article (10.1186/s13756-019-0599-y) contains supplementary material, which is available to authorized users.

antimicrobial resistance and infection control

Risk factors and outcomes in non-transplant patients with extended-spectrum beta-lactamase-producing Escherichia coli bacteremia: a retrospective study from 2013 to 2016