The Escherichia coli sequence type 648 complex (STc648) is an emerging lineage within phylogroup F-formerly included within phylogroup D-that is associated with multidrug resistance. Here, we designed and validated a novel multiplex PCR-based assay for STc648 that took advantage of (i) four distinctive single-nucleotide polymorphisms in icd allele 96 and gyrB allele 87, two of the multilocus sequence typing alleles that define ST648; and (ii) the typical absence within STc648 of uidA, an E. coli-specific gene encoding -glucuronidase. Within a diverse 212-strain validation set that included 109 STs other than STc648, from phylogroups A, B1, B2, C, D, E, and F, the assay exhibited 100% sensitivity (95% confidence interval [CI], 82% to 100%) and specificity (95% CI, 98% to 100%). It functioned similarly well in two distant laboratories that used boiled lysates or DNAzol-purified DNA as the template DNA. Thus, this novel multiplex PCR-based assay should enable any laboratory equipped for diagnostic PCR to rapidly, accurately, and economically screen E. coli isolates for membership in STc648.KEYWORDS Escherichia coli, antimicrobial resistance, diagnostics, molecular epidemiology, polymerase chain reaction, sequence type, strain typing E scherichia coli, an important cause of extraintestinal infections in humans and animals (1), is highly clonal. Each of its seven recognized phylogenetic groups (phylogroups) comprises numerous individual sequence types (STs), as defined by multilocus sequence typing (MLST) (2). Among thousands of distinct E. coli STs, a dozen or so ST complexes (i.e., groups of closely related STs) account for most human extraintestinal E. coli infections, and so are regarded as extraintestinal pathogenic E. coli (ExPEC) (3, 4); a similarly small proportion account for most antimicrobial-resistant E. coli infections (4-7). Thus, an E. coli isolate's ST can be highly informative regarding its likely pathogenic and resistance capabilities (8, 9).Phylogroup F is related closely to phylogroup B2, the origin of most human clinical E. coli isolates, and phylogroup D, the origin of most non-B2 ExPEC strains (2, 10). Prior to its recognition as a distinct phylogroup, its members were usually classified under group D, including by a PCR-based phylotyping assay that delineates only four major E. coli phylogroups (11). An updated version of that assay differentiates phylogroup F from phylogroup D (2).Within phylogroup F, the sequence type 648 complex (STc648) is reported increasingly as an emerging resistance-associated lineage (4). In multiple studies of resistant E. coli from diverse sources and locales, STc648 has been the first, second, or third most prevalent STc, accounting for up to 28% of isolates (12)(13)(14)(15)(16)(17)(18)(19). The reported resistance phenotypes for different STc648 strains include fluoroquinolones, extended-spectrum cephalosporins (CTX-M-type enzymes and CMY-2), carbapenems (OXA-48 and NDM and KPC variants), fosfomycin (fosA3), and colistin (mcr-1) (13, 14, 20-30). STc648 is...