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We identified 57 fosfomycin-resistant<jats:italic>Escherichia coli<\/jats:italic>from 465 urine-derived extended-spectrum<jats:italic>\u03b2<\/jats:italic>-lactamase (ESBL)-producing isolates from a Chinese hospital during 2010\u20132014. Of the 57 fosfomycin-resistant isolates, 51 (89\u00b75%) carried<jats:italic>fosA3<\/jats:italic>, and one carried<jats:italic>fosA1<\/jats:italic>. Divergent pulsed-field gel electrophoresis profiles and multi-locus sequence typing results revealed high clonal diversity in the<jats:italic>fosA3<\/jats:italic>-positive isolates. Conjugation experiments showed that the<jats:italic>fosA3<\/jats:italic>genes from 50 isolates were transferable, with IncFII or IncI1 being the most prevalent types of plasmids. The high prevalence of<jats:italic>fosA3<\/jats:italic>was closely associated with that of<jats:italic>bla<\/jats:italic><jats:sub>CTX-M<\/jats:sub>. Horizontal transfer, rather than clonal expansion, might play a central role in dissemination. Such strains may constitute an important reservoir of<jats:italic>fosA3<\/jats:italic>and<jats:italic>bla<\/jats:italic><jats:sub>CTX-M<\/jats:sub>, which may well be readily disseminated to other potential human pathogens. Since most ESBL-producing<jats:italic>E. coli<\/jats:italic>have acquired resistance to fluoroquinolones worldwide, further spread of<jats:italic>fosA3<\/jats:italic>in such<jats:italic>E. coli<\/jats:italic>isolates should be monitored closely.<\/jats:p>","DOI":"10.1017\/s0950268816002879","type":"journal-article","created":{"date-parts":[[2016,12,12]],"date-time":"2016-12-12T08:27:08Z","timestamp":1481531228000},"page":"818-824","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":43,"title":["High prevalence of fosfomycin resistance gene<i>fosA3<\/i>in<i>bla<\/i><sub>CTX-M<\/sub>-harbouring<i>Escherichia coli<\/i>from urine in a Chinese tertiary hospital during 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