الفهرس 
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Abstract
Background: E.coli is the most common cause of urinary tract infection (UTI) both in the community and hospital settings. Uropathogenic E.coli (UPEC) possesses a number of virulence factors that allow it to colonize and persist in the urinary tract. Of particular interest are the P pili and biofilm formation. The emergence of drug resistant E.coli is a global threat to the public health. Objectives: To determine the biofilm producing ability, antimicrobial susceptibility pattern, ESBL production and the presence of the adhesive pap gene (pyelonephritis associated pili) in E-coli strains isolated from Outpatients and Inpatients diagnosed with UTI. Methodology: The study was conducted on 40 Inpatients and 40 Outpatients diagnosed with UTI attending Ain Shams University Hospitals. E. coli Isolates were tested for antimicrobial susceptibility using disk diffusion method, ESBL production by ESBL detection discs, in vitro formation of biofilm on Congo red media, and detection of Pap gene using conventional PCR technique. Results: The prevalence of antibiotic resistance was significantly higher in E.coli isolates from inpatients group than those from the outpatients group. The prevalence of ESBL production, biofilm formation and pap gene among E. coli isolates was 55%, 82.5% & 40% respectively. ESBL production and biofilm formation were significantly higher in the inpatients with upper UTI than in patients with lower UTI (90- 38.5%) & (100-61.5%) respectively. There was no statistically significant difference between the 2 groups as regards the prevalence of pap gene. Conclusion: The prevalence of biofilm producing, ESBL producing and antibiotic resistant E.coli strains is more in the inpatients population particularly those with upper UTI. Special concern should be addressed to the spread of ESBL producing E.coli in the community. Pap gene is expressed equally in the outpatients and inpatients groups which highlights its importance in the establishment of UTI.