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Background  The prevalence of infections caused by extended-spectrum beta-lactamase producing  Escherichia coli  (ESBL- E. coli ) is increasing worldwide, but the setting in which this increase is occurring is not well defined. We compared trends and risk factors for ESBL- E. coli  bacteriuria in community vs healthcare settings.    Methods  We collected electronic health record data on all patients with  E. coli  isolated from urine cultures in a safety-net public healthcare system from January 2014 to March 2020. All analyses were stratified by healthcare-onset/associated (bacteriuria diagnosed > 48 h after hospital admission or in an individual hospitalized in the past 90 days or in a skilled nursing facility resident, N = 1277) or community-onset bacteriuria (bacteriuria diagnosed < 48 h after hospital admission or in an individual seen in outpatient clinical settings without a hospitalization in the past 90 days, N = 7751). We estimated marginal trends from logistic regressions to evaluate annual change in prevalence of ESBL- E. coli  bacteriuria among all bacteriuria. We evaluated risk factors using logistic regression models.    Results  ESBL- E. coli  prevalence increased in both community-onset (0.91% per year, 95% CI 0.56%, 1.26%) and healthcare-onset/associated (2.31% per year, CI 1.01%, 3.62%) bacteriuria. In multivariate analyses, age > 65 (RR 1.88, CI 1.17, 3.05), male gender (RR 2.12, CI 1.65, 2.73), and Latinx race/ethnicity (RR 1.52, CI 0.99, 2.33) were associated with community-onset ESBL- E. coli . Only male gender (RR 1.53, CI 1.03, 2.26) was associated with healthcare-onset/associated ESBL- E. coli .    Conclusions  ESBL- E. coli  bacteriuria frequency increased at a faster rate in healthcare-associated settings than in the community between 2014 and 2020. Male gender was associated with ESBL- E. coli  bacteriuria in both settings, but additional risks—age > 65 and Latinx race/ethnicity—were observed only in the community.    Supplementary Information  The online version contains supplementary material available at 10.1186/s13756-021-00983-y.

antimicrobial resistance and infection control

Trends in prevalence of extended-spectrum beta-lactamase-producing Escherichia coli isolated from patients with community- and healthcare-associated bacteriuria: results from 2014 to 2020 in an urban safety-net healthcare system