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Several techniques including disk diffusion and broth microdilution were used to identify patterns of antibiotic resistance, microtiter plate assay to measure biofilm formation, and PCR to evaluate the prevalence of different genes such as virulence factors, toxin-antitoxin systems, resistance to \u03b2-lactams and fluoroquinolone antibiotics of<jats:italic>E. coli<\/jats:italic>strains. Additionally, the genetic linkage of the isolates was analyzed using the Enterobacterial Repeat Intergenic Consensus Polymerase Chain Reaction (ERIC-PCR) method.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The results showed that higher frequency of BSI caused by<jats:italic>E. coli<\/jats:italic>in man than female patients, and patients with acute leukemia had a higher frequency of BSI. Ampicillin and Amoxicillin-clavulanic acid showed the highest resistance, while Imipenem was identified as a suitable antibiotic for treating BSIs by<jats:italic>E. coli<\/jats:italic>. Multidrug-resistant (MDR) phenotypes were present in 22% of the isolates, while 53% of the isolates were ESBL-producing with the<jats:italic>bla<\/jats:italic>CTX-M gene as the most frequent \u03b2-lactamase gene. The fluoroquinolone resistance genes<jats:italic>qnr<\/jats:italic>B and<jats:italic>qnr<\/jats:italic>S were present in 50% and 28% of the isolates, respectively. More than 80% of the isolates showed the ability to form biofilms. The<jats:italic>tra<\/jats:italic>T gene was more frequent than other virulence genes. The toxin-antitoxin system genes (<jats:italic>maz<\/jats:italic>F,<jats:italic>ccd<\/jats:italic>AB, and<jats:italic>rel<\/jats:italic>B) showed a comparable frequency. The genetic diversity was detected in<jats:italic>E. coli<\/jats:italic>isolates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our results demonstrate that highly diverse, resistant and pathogenic<jats:italic>E. coli<\/jats:italic>clones are circulating among leukemia patients in Iranian hospitals. More attention should be paid to the treatment and management of<jats:italic>E. coli<\/jats:italic>bloodstream infections in patients with leukemia.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s12866-023-03081-8","type":"journal-article","created":{"date-parts":[[2023,11,4]],"date-time":"2023-11-04T06:02:56Z","timestamp":1699077776000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Evaluation of antibiotic resistance, toxin-antitoxin systems, virulence factors, biofilm-forming strength and genetic linkage of Escherichia coli strains isolated from bloodstream infections of leukemia patients"],"prefix":"10.1186","volume":"23","author":[{"given":"Mahdaneh","family":"Roshani","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Taheri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alireza","family":"Goodarzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rassoul","family":"Yosefimashouf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leili","family":"Shokoohizadeh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,11,4]]},"reference":[{"issue":"3","key":"3081_CR1","doi-asserted-by":"publisher","first-page":"e58121","DOI":"10.1371\/journal.pone.0058121","volume":"8","author":"C Huoi","year":"2013","unstructured":"Huoi C, Vanhems P, Nicolle M-C, Michallet M, Benet T. 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The experiments in our study were conducted in accordance to the relevant guidelines and regulations or in accordance to the Declaration of Helsinki. Informed consent was obtained from all patients and from the parents or legal guardians of children participating in the study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"327"}}