Materials and Methods: A narrative literature review was conducted based on 14 peer-reviewed articles and institutional reports addressing resistance mechanisms and the epidemiology of E. coli strains in Europe and globally. Conclusions: Resistance in E. coli is driven by complex, cross-sectoral dynamics. Effective containment strategies should include rational antibiotic use in primary care, restrictions on veterinary antimicrobial use, improved diagnostics, modernized wastewater infrastructure, and inclusion of travel history in AMR risk assessments. The persistent detection of blaCTX-M and mcr-1 in all reservoirs highlights the need for a unified One Health approach.