The trend and potential factors of the longitudinal antimicrobial resistance of Escherichia coli strains in recent decades worldwide.

Antimicrobial resistance (AMR) poses a critical threat to global public health in the 21st century. Escherichia coli (E. coli), as a major bacterial pathogen, is widely distributed in humans, animals, and the environment, is not only a common pathogen causing urinary tract infections, bacteremia, and infectious diarrhea, but also one of the main pathogens leading to the sharp increase of multi-drug resistant strains. Therefore, understanding the long-term changing patterns of drug resistance in E. coli and exploring the key driving factors of drug resistance development are of vital importance for curbing the spread of AMR. Here, we observed the patterns of antibiotic resistance genes (ARGs) in 3085 E. coli isolates collected over the past 70 years since 1948. Our results indicated that the count of ARGs in E. coli had gradually increased in recent decades (P < 0.001). In particular, we found that the human development index may have indirectly contributed to the rise in antibiotic resistance in E. coli isolates by promoting the use of antibiotics. Finally, generalized linear models combined with restricted cubic splines showed that global antibiotic consumption, mobile genetic elements, and climatic factors all affected the count of ARGs in E. coli isolates. Overall, this study monitored the long-term trend of ARGs in E. coli isolates, analyzed the potential influencing factors of ARGs in these isolates, and offered a theoretical framework for controlling the global risk of antibiotic resistance.