title: Carbapenemase-producing Enterobacteriaceae in Finland: the first years (2008-11).
abstract: OBJECTIVE
  Carbapenemase-producing Enterobacteriaceae (CPE) are becoming a global problem; they are often resistant to nearly all available antibiotics. Here we report details on all Finnish CPE isolates found until the end of 2011: carbapenemase genes, travel history and multilocus sequence typing (MLST) data.
  
  
  METHODS
  Enterobacteriaceae sent to the Antimicrobial Resistance Unit of the National Institute for Health and Welfare were tested for susceptibility to carbapenems, screened for carbapenemases by PCR and isolates with decreased susceptibility to carbapenems were tested for hydrolysis of imipenem. Carbapenemase-producing Escherichia coli and Klebsiella pneumoniae isolates were typed by MLST.
  
  
  RESULTS
  In all, 26 CPE strains were found from 25 patients: 10 with OXA-48-like enzymes, 5 with KPC, 4 with VIM, 3 with NDM, 3 with IMI/NMC-A and 1 with GES-14. The species were K. pneumoniae (n = 16), E. coli (n = 6), Enterobacter cloacae (n = 3) and Raoultella planticola (n = 1). Of the 25 patients, 18 had a known travel history/hospital transfer from abroad. Local spread/transmission was suspected in 2011, but there were no hospital outbreaks. The K. pneumoniae multilocus sequence types ST258, ST182, ST147, ST244, ST14, ST13, ST383, ST101 and ST15, and the E. coli sequence types ST38 and ST90 were found. Many of these are global epidemic clones.
  
  
  CONCLUSIONS
  CPE strains are increasingly found in Finland, but still at a very low prevalence.
authors.affiliation: Antimicrobial Resistance Unit, National Institute for Health and Welfare, Kiinamyllynkatu 13, FIN-20520 Turku, Finland. monica.osterblad@thl.fi
authors.forename: Monica
authors.initials: M
authors.lastname: Österblad
authors.forename: Juha
authors.initials: J
authors.lastname: Kirveskari
authors.forename: Antti J
authors.initials: AJ
authors.lastname: Hakanen
authors.forename: Päivi
authors.initials: P
authors.lastname: Tissari
authors.forename: Martti
authors.initials: M
authors.lastname: Vaara
authors.forename: Jari
authors.initials: J
authors.lastname: Jalava
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001426:Bacterial Proteins / Q000235:genetics*; D002648:Child; D002675:Child, Preschool; D004269:DNA, Bacterial / Q000235:genetics; D016972:Enterobacter cloacae; D004755:Enterobacteriaceae / Q000145:classification / Q000201:enzymology* / Q000235:genetics / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000382:microbiology*; D004926:Escherichia coli; D005260:Female; D005387:Finland / Q000453:epidemiology; D005838:Genotype; D006801:Humans; D007711:Klebsiella pneumoniae; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D058885:Multilocus Sequence Typing; D016133:Polymerase Chain Reaction; D015995:Prevalence; D014195:Travel; D001618:beta-Lactamases / Q000235:genetics*
chemical_list: D001426:Bacterial Proteins; D004269:DNA, Bacterial; D001618:beta-Lactamases; C063912:carbapenemase