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54 (2.14; 3.01)) and Klebsiella (RR?=?2.02 (1.59; 2.58)). Most ESBLs were CTX-M enzymes (84.9%), with [http://www.selleckchem.com/products/DAPT-GSI-IX.html DAPT datasheet] a significant increase between 2006 and 2009 (74.6% vs. 89.3%, p?[https://en.wikipedia.org/wiki/Sulfatase Sulfatase] the psychiatry and cancer units. Relative risks (RRs) for each unit group showed a higher acquisition risk in intensive care units (RR?=?1.78 (1.60; 2.02)) and haematological units (RR?=?3.07 (2.79; 3.05)), in both clinical and screening samples. Because many ESBL producers have been identified from rectal swabbing samples, we focused on ESBL-producing strains that had been isolated in clinical samples (n?=?439). We established the clinical incidence of ESBLs as the number of new ESBL-producing strains isolated from clinical samples per year relative to 1000 hospitalization days (HD). This incidence increased by over 400% (0.391 cases/1000 hospitalization days in 2009 vs. 0.092 in 2006) and exceeded 1 case/1000 hospitalization days in intensive care units and emergency departments (Figs?1 and 2, Table?1). The incidence in 2006, 2007 and 2008 was lower but in 2009 was greater than the mean overall incidence in 333 health institutions that collaborated [http://www.selleckchem.com/products/Adriamycin.html Doxorubicin] in a national BMR-Raisin network [16]. These findings also correlate with increased ESBL incidence in Europe [7]. The distribution of different ESBL producers was unchanged in various unit groups. The three predominant enzymes (CTX-M-14, CTX-M-15 and CTX-M-1) were found in isolates from all clinical unit groups each year, except psychiatry where few ESBL producers were identified (Fig.?2b). In urine samples, CTX-M-14, CTX-M-15 and CTX-M-1 were observed, respectively, in 25.2%, 24.4% and 18.3% of the strains. Otherwise, three major ESBLs were identified from strains isolated in blood samples: E.