BackgroundUrinary tract infections caused by extended-spectrum beta-lactamase (ESBL)-producingEscherichia coli(ESBL-E. coli) may occur as outbreaks due to common-source exposures. Yet, it is currently unknown if they cluster geographically as would be expected as part of an outbreak.MethodsWe collected electronic health record data on all patients living in San Francisco with culture-documented community-onsetE. colibacteriuria in a safety-net public healthcare system from January 2014 to March 2020 (diagnosed < 48 hours after hospital admission or in outpatient clinical settings without a hospitalization in the past 90 days). We assessed the presence of spatial clusters of (1) ESBL-E. colibacteriuria episodes, and (2) individuals with any ESBL-E. colibacteriuria episode, with Global and Local Moran’s I. We evaluated differences in prevalence of bacteriuria recurrence by ESBL-production by Poisson regression.ResultsOut of 4,304 unique individuals, we identified spatial clusters of ESBL-E. colibacteriuria episodes (n = 461) compared to non-ESBL-E. colibacteriuria episodes (n = 5477; Global Moran’s p < 0.001). Spatial clusters of individuals with any bacteriuria caused by ESBL-E. coliwere not identified (p = 0.43). Bacteriuria recurrence was more likely to occur with ESBL-E. coli(odds ratio [OR] 2.78, 95% confidence interval [95% CI] 2.10, 3.66, p < 0.001), particularly after an initial ESBL-E. colibacteriuria episode (OR 2.27, 95% CI 1.82, 2.83, p < 0.001).ConclusionWe found spatial clusters of ESBL-E. colibacteriuria episodes. However, this was partly explained by clustering within individuals more than between individuals, as having an ESBL-E. colibacteriuria was associated with recurrence with ESBL-E. coli.