title: Nosocomial bloodstream infections caused by Escherichia coli and Klebsiella pneumoniae resistant to third-generation cephalosporins, Finland, 1999-2013: Trends, patient characteristics and mortality.
abstract: BACKGROUND
  Few systematically collected multi-centre surveillance data on nosocomial bloodstream infections (BSI) caused by extended-spectrum β-lactamase (ESBL) producing Escherichia coli or Klebsiella pneumoniae have been published.
  
  
  OBJECTIVE
  To evaluate trends, patient characteristics and mortality of such infections, nosocomial BSI data reported by the 4-17 hospitals participating in the prospective laboratory-based surveillance during 1999-2013 were analysed.
  
  
  METHODS
  Data were collected by local infection control nurses, patient-days were obtained from the hospital's administrative database, and dates of deaths from the population registry. Resistance to third-generation cephalosporins was further examined in the national reference laboratory.
  
  
  RESULTS
  A total of 16 028 nosocomial BSIs were identified; 2217 (14%) were caused by E. coli and 661 (4%) by K. pneumoniae; 207 (7%) were non-susceptible to third-generation cephalosporins, with an increasing trend from 0% in 1999 to 17% in 2013. Patient characteristics did not differ significantly between BSIs caused by third-generation susceptible and resistant E. coli and K. pneumonia, but the case fatality tended to be higher. Most (88%) of the isolates reported as non-susceptible to third-generation cephalosporins had ESBL phenotype, CTX-M (79%) being the most common enzyme.
  
  
  CONCLUSIONS
  A sharp increase in nosocomial BSIs caused by ESBL producing bacteria was observed. Identification of patients for screening pose a challenge, emphasising the role of infection control guidelines and antibiotic policy in prevention.
authors.affiliation: a Department of Infectious Diseases , Inflammation Centre, Helsinki University Hospital and University of Helsinki, Inflammation Centre , Helsinki , Finland ;|b Institute of Health and Welfare , Department of Infectious Disease Surveillance and Control , Helsinki , Finland.
authors.forename: Timi
authors.initials: T
authors.lastname: Martelius
authors.affiliation: b Institute of Health and Welfare , Department of Infectious Disease Surveillance and Control , Helsinki , Finland.
authors.forename: Jari
authors.initials: J
authors.lastname: Jalava
authors.affiliation: b Institute of Health and Welfare , Department of Infectious Disease Surveillance and Control , Helsinki , Finland.
authors.forename: Tommi
authors.initials: T
authors.lastname: Kärki
authors.affiliation: b Institute of Health and Welfare , Department of Infectious Disease Surveillance and Control , Helsinki , Finland.
authors.forename: Teemu
authors.initials: T
authors.lastname: Möttönen
authors.affiliation: b Institute of Health and Welfare , Department of Infectious Disease Surveillance and Control , Helsinki , Finland.
authors.forename: Jukka
authors.initials: J
authors.lastname: Ollgren
authors.affiliation: b Institute of Health and Welfare , Department of Infectious Disease Surveillance and Control , Helsinki , Finland.
authors.forename: Outi
authors.initials: O
authors.lastname: Lyytikäinen
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D018550:Cephalosporin Resistance; D002511:Cephalosporins / Q000494:pharmacology / Q000627:therapeutic use; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D004926:Escherichia coli / Q000187:drug effects / Q000201:enzymology / Q000302:isolation & purification*; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D007710:Klebsiella Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000201:enzymology / Q000302:isolation & purification*; D008875:Middle Aged; D011446:Prospective Studies; D001618:beta-Lactamases / Q000096:biosynthesis
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D001618:beta-Lactamases
keywords: ESBL; Nosocomial; blood stream infection; surveillance