Abstract

Antimicrobial resistance (AMR) is a critical global health crisis that undermines the efficacy of standard infectious disease treatments. Within this landscape, multidrug-resistant (MDR) Escherichia coli is especially formidable due to its high genetic plasticity and its capacity for both intestinal and extraintestinal pathogenesis. The proliferation of these MDR strains is fueled by horizontal gene transfer and mobile genetic elements, which allow resistance determinants to bridge human, animal and environmental reservoirs. Fortunately, recent breakthroughs in genomics and bioinformatics, specifically Whole Genome Sequencing (WGS) now allow for the comprehensive mapping of resistomes and virulence factors. By identifying globally disseminated ‘high-risk’ clones, these computational tools have become indispensable for tracing transmission pathways and predicting resistance phenotypes in real time. This review summarizes current genomic insights into MDR E. coli, with emphasis on resistance mechanisms, mobile genetic elements, phylogenetic diversity, and bioinformatics resources for surveillance and analysis. It also discusses the public health implications of rising resistance, including limited therapeutic options and increased risk of treatment failure. Integrating genomic surveillance with advanced analytical approaches will be essential for early detection, effective control strategies, and the development of novel interventions to combat the growing threat of antimicrobial resistance.