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This study investigated the phenotypic and genotypic resistance profiles of\n                      <jats:italic>Escherichia coli<\/jats:italic>\n                      (\n                      <jats:italic>E. coli<\/jats:italic>\n                      ) isolates from HWW in Shiraz, Iran. Thirty-six HWW samples (18 influent, 18 effluent) were collected weekly over six weeks from three major hospitals.\n                      <jats:italic>E. coli<\/jats:italic>\n                      isolates were identified and assessed for antimicrobial susceptibility, extended-spectrum \u03b2-lactamase (ESBL) and carbapenemase production, resistance genes, phylogroups, and sequence types (STs).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 68\n                      <jats:italic>E. coli<\/jats:italic>\n                      isolates were obtained (33 influent, 35 effluent). High resistance rates were observed for ampicillin (97.1%), cefazolin, and amoxicillin\/clavulanic acid (86.8%). The lowest resistance rates were to imipenem (5.9%), meropenem (13.2%), and chloramphenicol (19.1%). MDR and extensively drug-resistant (XDR) profiles were identified in 80.9% and 22.1% of isolates, respectively. ESBL production was found in 57.4% of isolates. All nine carbapenem-resistant isolates were tested by both modified carbapenem inactivation method (mCIM) and EDTA-CIM (eCIM); eight (88.9%) were positive by mCIM, while all were negative by eCIM. Resistance genes detected included\n                      <jats:italic>bla<\/jats:italic>\n                      TEM (39.7%),\n                      <jats:italic>bla<\/jats:italic>\n                      CTX-M (33.8%), and\n                      <jats:italic>bla<\/jats:italic>\n                      SHV (2.9%). Three isolates carried\n                      <jats:italic>bla<\/jats:italic>\n                      OXA-48, while one carried\n                      <jats:italic>bla<\/jats:italic>\n                      IMP and another carried\n                      <jats:italic>bla<\/jats:italic>\n                      VIM. Phylogroup B2 was most frequent (22.1%), with ST131 being the dominant type (33.8%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      In conclusion, HWW may serve as a potential reservoir for resistant and pathogenic\n                      <jats:italic>E. coli<\/jats:italic>\n                      isolates, indicating the importance of monitoring wastewater as a step in addressing the issue of AMR.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12866-025-04398-2","type":"journal-article","created":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T13:01:54Z","timestamp":1760014914000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["High prevalence of MDR and XDR Escherichia coli in hospital wastewater from Shiraz, Iran: ESBL and carbapenemase production"],"prefix":"10.1186","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8457-4057","authenticated-orcid":false,"given":"Abolfazl Rafati","family":"Zomorodi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3499-2899","authenticated-orcid":false,"given":"Mohammad Reza","family":"Samaei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2013-8694","authenticated-orcid":false,"given":"Himen","family":"Salimizand","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7456-753X","authenticated-orcid":false,"given":"Mohammad Hassan Parvizi","family":"Mashhadi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4993-4034","authenticated-orcid":false,"given":"Mohammad","family":"Motamedifar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,10,9]]},"reference":[{"issue":"3","key":"4398_CR1","doi-asserted-by":"publisher","first-page":"e21","DOI":"10.1002\/puh2.21","volume":"1","author":"DEI Lucero-Prisno","year":"2022","unstructured":"Lucero-Prisno DEI, Kouwenhoven M, Adebisi YA, Miranda AV, Gyeltshen D, Suleman MH, et al. 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