Aims: Escherichia coli is one of the most important causes of hospital-acquired and community-acquired infections in humans and can easily gain resistance to antibiotics consumed by humans and animals. The main objectives of this study were to assess antibiotic resistance outlines and detection of antibiotic resistance and virulence genes, including the bla_CTX-M and pap among the E. coli isolates recovered from the urine of patients referred to Shaheed Madani Hospital (Bejestan, Northeast of Iran).
Methods & Materials: This cross-sectional study was conducted from April 2016 to March 2018. A total of 100 non-duplicate isolates of E. coli were recovered from the urine of patients referred to Shaheed Madani Hospital (Bejestan, Northeast of Iran). Antimicrobial susceptibility test and extended-spectrum-beta-Lactamases (ESBLs) production were performed according to Clinical and Laboratory Standards Institute (CLSI) guidelines. The polymerase chain reaction was carried out for the detection and distribution of the pap virulence gene and bla_CTX-M antibiotic resistance gene. 
Findings: About 100 E. coli isolates were recovered from the urine sample of patients (21 male, and 79 female). Carbapenems were the most effective antibiotic against isolates. Four strains (4%) were resistant to colistin. Twenty-seven strains (27%) were ESBL-positive. Carbapenems were the most effective antibiotic against ESBL-positive strains. Also, 82% and 89% of isolates were bla_CTX-M and pap gene positive, respectively. 
Conclusion: This study has shown that ESBL-positive strains with a high level of drug resistance and virulence factors are a potential risk for hospital wards. Colistin resistant isolates found in our study are quite alarming.