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?coli and blaSHV-12-producing K.?pneumoniae isolates were detected. Clonal clusters of both species persisted throughout the study period. The proportion of extended-spectrum ��-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae has been increasing worldwide E-64 in both community-acquired and healthcare-associated infections [1�C4]. Increasing frequencies of ESBL-positive E.?coli and K.?pneumoniae were observed in the city of Helsinki during the 2000s. We conducted this study to identify longitudinal trends in the emergence of ESBL-producing E.?coli and K.?pneumoniae strains, and to characterize their molecular epidemiology. (These results were presented in part at the 6th International Conference of the Hospital Infection Society, Amsterdam, October 2006.) The city of Helsinki is a large, well-defined geographical area with a public healthcare system providing virtually all healthcare to its more than a million inhabitants. The healthcare system consists of a tertiary-care Epigenetic Reader Domain inhibitor hospital, seven city hospitals and 30 primary-care offices. The study population consisted of all patients treated by the Helsinki city healthcare system from whom an E.?coli or K.?pneumoniae isolate, with a resistance phenotype implying the presence of an ESBL, was isolated between 2000 and 2004. Altogether, 746 patients (of whom 48 were bacteraemic) with ESBL-producing E.?coli and 91 with ESBL-producing K.?pneumoniae colonization or infection, were included. Only one isolate per patient was studied. An isolate was defined as healthcare-associated if it was obtained >48?h after hospital admission, or the patient had been hospitalized within a year prior to culture (excluding clinic visits), or if the patient was a resident in a long-term-care facility; all Selleckchem R428 other isolates were defined as community-acquired. The study protocol was approved by the ethics committee of the Helsinki city hospitals. The increase in ESBL-producing E.?coli (p?65?years), with only 13 of patients being children. Of the non-bacteraemic E.?coli isolates, 90% were isolated from urine, 8% from wounds, and 2% from pus. MICs were determined according to CLSI guidelines [5,6]. All isolates were screened by PCR for ESBL genes, and pulsed-field gel electrophoresis (PFGE) analysis was performed, as previously described [7�C9]. The isolates were considered to belong to the same PFGE type if the coefficient of similarity was ��85%. The number of ESBL-producing E.?coli isolates, from urine, blood and pus specimens, increased significantly (p?
