biostudies-literatureCheng YYEn Chu Kong HospitalTaipei Veterans General HospitalNational Science and Technology CouncilCGMH-NYCU Joint Research ProgramChina Medical University67https://www.ebi.ac.uk/biostudies/studies/S-EPMC12379366biostudies-literatureUnknown17(1)Carbapenem-resistant Escherichia coli (CREC) can cause persistent or multi-site infections, leading to significant clinical challenges due to the limited availability of effective antibiotics. However, the within-host evolution of CREC and its impact on infection patterns remain poorly understood. This study aims to characterize CREC isolates from patients with recurrent or multi-site infections to elucidate the relationship between bacterial adaptation within the host and infection dynamics, thereby addressing a critical gap in our understanding of CREC pathogenesis. Genotypic analysis, including Nanopore whole-genome sequencing, and phenotypic comparisons were performed on CREC isolates from individual patients. Pulsed-field gel electrophoresis (PFGE) patterns revealed that 18 patients wGut pathogensTracing the evolutionary dynamics of carbapenem-resistant Escherichia coli in recurrent and multi-site infections.PMC12379366CGMH-NYCU-113-CORPG8P0211CMU113-N-14ECKH_W11201V113C-200112-2320-B-A49-045-MY3Fan YHZhang YZTsai YMHo DZChen YCCheng YYLee YHWang MCThuy TTDKao CYTeng CHKuo PYBregente CJBChuang YCfalseTracing the evolutionary dynamics of carbapenem-resistant Escherichia coli in recurrent and multi-site infections.Carbapenem-resistant Escherichia coli (CREC) can cause persistent or multi-site infections, leading to significant clinical challenges due to the limited availability of effective antibiotics. However, the within-host evolution of CREC and its impact on infection patterns remain poorly understood. This study aims to characterize CREC isolates from patients with recurrent or multi-site infections to elucidate the relationship between bacterial adaptation within the host and infection dynamics, thereby addressing a critical gap in our understanding of CREC pathogenesis. Genotypic analysis, including Nanopore whole-genome sequencing, and phenotypic comparisons were performed on CREC isolates from individual patients. Pulsed-field gel electrophoresis (PFGE) patterns revealed that 18 patients w2025-01-01T00:00:00Z2025 Aug2026-05-28T02:20:25.103Z2026-04-08T02:07:59.633ZS-EPMC123793664085941010.1186/s13099-025-00746-9