The aim of this study was to investigate beta-lactam resistance in Escherichia coli and Klebsiella spp. blood culture isolates in Finland. Special attention was given to extended-spectrum beta-lactamases. A total of 566 Escherichia coli and 108 Klebsiella spp. blood culture isolates were collected from hospitals throughout Finland and their susceptibility to beta-lactam antibiotics studied. Twenty percent of Escherichia coli and 69% of Klebsiella spp. strains were resistant to ampicillin. The mechanisms of resistance were studied by hybridization, isoelectric focusing and the clavulanate double-disk potentiation test. Of the ampicillin-resistant Escherichia coli strains, 83% produced TEM-1. Of the ampicillin-resistant Klebsiella spp. strains, 43% produced SHV-1. Only nine Escherichia coli and three Klebsiella spp. isolates were resistant to cefuroxime (MIC > or = 32 micrograms/ml), and none were resistant to third-generation cephalosporins. These data were compared with cefuroxime and third-generation cephalosporin consumption levels in Finnish hospitals. Although the use of cephalosporins is far more extensive in Finland than in other Scandinavian countries, none of the isolates produced extended-spectrum beta-lactamases. In conclusion, resistance to cefuroxime has remained rare in Finland, and cefuroxime is still an alternative to third-generation cephalosporins in the treatment of septicemia.
OBJECTIVE: To investigate the antimicrobial resistance of Escherichia coli and Klebsiella spp. from pus, urine and respiratory specimens, with particular emphasis on the detection of third-generation cephalosporin resistance. METHODS: E. coli (698) and Klebsiella sp. (476) strains from pus, respiratory and urinary specimens from hospital patients were collected from 19 laboratories. Data about consumption of third-generation cephalosporins and cefuroxime were collected from 24 hospitals. Antimicrobial susceptibility was tested with disk diffusion in primary laboratories and by an agar dilution method. Extended-spectrum beta-lactamase (ESBL) production was studied with a double disk synergy test and an ESBL Etest. The beta-lactamase classes were characterized with polymerase chain reaction probes of the TEM and SHV beta-lactamase families and isoelectric focusing. RESULTS: Only 0.6% of E. coli and 2.3% of Klebsiella spp. strains were resistant or intermediately resistant to cefotaxime, ceftriaxone and/or ceftazidime. The ESBL producers detected comprised one E. coli harboring TEM-like genes and five Klebsiella pneumoniae strains, two of which harbored SHV-like genes, two TEM-like genes and one both. Although consumption of cefuroxime has increased in the years 1990-1994, from 3.48 to 5.84 defined daily doses/100 bed-days, and the consumption of third-generation cephalosporins from 1.25 to 1.94 defined daily doses/100 bed-days, cefuroxime resistance of E. coli was only 3%. CONCLUSION: Although the use of broad-spectrum cephalosporins has increased, resistance to second- and third-generation cephalosporins is still rare in Finland.
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