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is the leading cause of urinary tract infections (UTI) and bloodstream infections (BSI), and the emergence of antimicrobial resistance (AMR) in causes concern.


To investigate changes in the proportion of extended-spectrum β-lactamase (ESBL) producing isolates among isolated from urine and blood in Finland during 2008–2019.


Susceptibility testing of 1,568,488 urine (90% female, 10% male) and 47,927 blood isolates (61% female, 39% male) from all Finnish clinical microbiology laboratories during 2008–2019 was performed according to guidelines from the Clinical and Laboratory Standard Institute during 2008–2010 and the European Committee on Antimicrobial Susceptibility Testing during 2011–2019. A binomial regression model with log link compared observed trends over time and by age group and sex.


The annual proportion of ESBL-producing  isolates among from blood cultures increased from 2.4% (23/966) to 8.6% (190/2,197) among males (average annual increase 7.7%; 95% CI: 4.4–11.0%, p < 0.01) and from 1.6% (28/1,806) to 6.4% (207/3,218) among females (9.3%; 95% CI: 4.8–14.0%, p < 0.01). In urine cultures, the proportion of ESBL-producing isolates increased from 2.2% (239/10,806) to 7.2% (1,098/15,297) among males (8.8%; 95% CI: 6.5–11.3%, p < 0.01) and from 1.0% (1,045/108,390) to 3.1% (3,717/120,671) among females (8.6%; 95% CI: 6.3–11.0%, p < 0.01). A significant increase was observed within most age groups.


Considering the ageing population and their risk of BSI and UTI, the increase in the annual proportions of ESBL-producing  is concerning, and these increasing trends should be carefully monitored.


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  1. Bonten M, Johnson JR, van den Biggelaar AHJ, Georgalis L, Geurtsen J, de Palacios PI, et al. Epidemiology of Escherichia coli Bacteremia: A Systematic Literature Review. Clin Infect Dis. 2021;72(7):1211-9.  https://doi.org/10.1093/cid/ciaa210  PMID: 32406495 
  2. MacKinnon MC, McEwen SA, Pearl DL, Lyytikäinen O, Jacobsson G, Collignon P, et al. Increasing incidence and antimicrobial resistance in Escherichia coli bloodstream infections: a multinational population-based cohort study. Antimicrob Resist Infect Control. 2021;10(1):131.  https://doi.org/10.1186/s13756-021-00999-4  PMID: 34488891 
  3. Kontula KSK, Skogberg K, Ollgren J, Järvinen A, Lyytikäinen O. Population-Based Study of Bloodstream Infection Incidence and Mortality Rates, Finland, 2004-2018. Emerg Infect Dis. 2021;27(10):2560-9.  https://doi.org/10.3201/eid2710.204826  PMID: 34546161 
  4. World Health Organization (WHO) Regional Office for Europe and European Centre for Disease Prevention and Control (ECDC). Surveillance of antimicrobial resistance in Europe, 2020 data. Executive Summary. Stockholm: ECDC; 2021. Available from: https://www.ecdc.europa.eu/en/publications-data/surveillance-antimicrobial-resistance-europe-2020
  5. National Veterinary Institute (SVA). Swedres-Svarm 2019. Sales of antibiotics and occurrence of resistance in Sweden. Stockholm: SVA; 2020. Available from: https://www.sva.se/en/our-topics/antibiotics/svarm-resistance-monitoring/swedres-svarm-reports/
  6. Norwegian Institute of Public Health (NIPH) and the Norwegian Veterinary Institute. NORM and NORM-VET. Usage of Antimicrobial Agents and Occurrence of Antimicrobial Resistance in Norway. Oslo: NIPH; 2021. Available from: https://www.fhi.no/en/publ/2021/norm-and-norm-vet/
  7. Statens Serum Institut (SSI). DANMAP 2019 - Use of antimicrobial agents and occurrence of antimicrobial resistance in bacteria from food animals, food and humans in Denmark. Copenhagen: SSI; 2020. Available from: https://www.danmap.org/reports/2019
  8. Räisänen K, Ilmavirta H, Jalava J, Vuento R, Hakanen A, Salmenlinna S, et al. Bakteerien mikrobilääkeresistenssi Suomessa - Finres 2019. [Finnish Antimicrobial resistance report - Finres 2019]. Helsinki: Finnish Institute for Health and Welfare (THL); 2020. Finnish. Available from: https://urn.fi/URN:ISBN:978-952-343-588-9
  9. MacKinnon MC, McEwen SA, Pearl DL, Lyytikäinen O, Jacobsson G, Collignon P, et al. Mortality in Escherichia coli bloodstream infections: a multinational population-based cohort study. BMC Infect Dis. 2021;21(1):606.  https://doi.org/10.1186/s12879-021-06326-x  PMID: 34172003 
  10. European Centre for Disease Prevention and Control (ECDC). Antimicrobial resistance in the EU/EEA (EARS-Net) - Annual Epidemiological Report for 2019. Stockholm: ECDC; 2020. Available from: https://www.ecdc.europa.eu/en/publications-data/surveillance-antimicrobial-resistance-europe-2019
  11. World Health Organization (WHO) Regional Office for Europe and European Centre for Disease Prevention and Control (ECDC). Antimicrobial resistance surveillance in Europe 2022 (2020 data). Stockholm: ECDC; 26 Jan 2022. Available from: https://www.ecdc.europa.eu/en/publications-data/antimicrobial-resistance-surveillance-europe-2022-2020-data
  12. Brolund A, Edquist PJ, Mäkitalo B, Olsson-Liljequist B, Söderblom T, Wisell KT, et al. Epidemiology of extended-spectrum β-lactamase-producing Escherichia coli in Sweden 2007-2011. Clin Microbiol Infect. 2014;20(6):O344-52.  https://doi.org/10.1111/1469-0691.12413  PMID: 24118431 
  13. Finnish Institute for Health and Welfare (THL). Finres kuutio (julkinen). [Finres cube (public)]. [Accessed: 8 Oct 2021]. Finnish. Available from: https://sampo.thl.fi/pivot/prod/fi/finres/lite/fact_lite
  14. Clinical & Laboratory Standards Institute (CLSI). CLSI Guidelines. Pennsylvania: CLSI. [Accessed: 22 Sep 2023]. Available from: https://clsi.org
  15. European Committee on Antimicrobial Susceptibility Testing (EUCAST). Växjö: EUCAST. [Accessed: 22 Sep 2023]. Available from: https://www.eucast.org/
  16. Raphael E, Glymour MM, Chambers HF. Trends in prevalence of extended-spectrum beta-lactamase-producing Escherichia coli isolated from patients with community- and healthcare-associated bacteriuria: results from 2014 to 2020 in an urban safety-net healthcare system. Antimicrob Resist Infect Control. 2021;10(1):118.  https://doi.org/10.1186/s13756-021-00983-y  PMID: 34380549 
  17. van Driel AA, Notermans DW, Meima A, Mulder M, Donker GA, Stobberingh EE, et al. Antibiotic resistance of Escherichia coli isolated from uncomplicated UTI in general practice patients over a 10-year period. Eur J Clin Microbiol Infect Dis. 2019;38(11):2151-8.  https://doi.org/10.1007/s10096-019-03655-3  PMID: 31440915 
  18. Mesa Varona O, Chaintarli K, Muller-Pebody B, Anjum MF, Eckmanns T, Norström M, et al. Monitoring antimicrobial resistance and drug usage in the human and livestock sector and foodborne antimicrobial resistance in six European countries. Infect Drug Resist. 2020;13:957-93.  https://doi.org/10.2147/IDR.S237038  PMID: 32308439 
  19. European Centre for Disease Prevention and Control (ECDC). Surveillance atlas of infectious diseases. Stockholm: ECDC. [Accessed: 17 Nov 2021]. Available from: https://atlas.ecdc.europa.eu/public/index.aspx?Dataset=27&HealthTopic=4.
  20. Kaye KS, Gupta V, Mulgirigama A, Joshi AV, Scangarella-Oman NE, Yu K, et al. Antimicrobial Resistance Trends in Urine Escherichia coli Isolates From Adult and Adolescent Females in the United States From 2011 to 2019: Rising ESBL Strains and Impact on Patient Management. Clin Infect Dis. 2021;73(11):1992-9.  https://doi.org/10.1093/cid/ciab560  PMID: 34143881 
  21. Rodríguez-Baño J, Picón E, Gijón P, Hernández JR, Ruíz M, Peña C, et al. Community-onset bacteremia due to extended-spectrum β-lactamase-producing Escherichia coli: risk factors and prognosis. Clin Infect Dis. 2010;50(1):40-8.  https://doi.org/10.1086/649537  PMID: 19995215 
  22. Rodríguez-Baño J, Alcalá JC, Cisneros JM, Grill F, Oliver A, Horcajada JP, et al. Community infections caused by extended-spectrum beta-lactamase-producing Escherichia coli. Arch Intern Med. 2008;168(17):1897-902.  https://doi.org/10.1001/archinte.168.17.1897  PMID: 18809817 
  23. Working group set up by the Finnish Medical Society Duodecim and the Finnish Cardiac Society. Virtsatieinfektiot. [Urinary tract infections]. Current Care Guidelines. Helsinki: The Finnish Medical Society Duodecim; 2019. [Accessed: 26 Jun 2022]. Finnish. Available from: www.kaypahoito.fi
  24. John G, Mugnier E, Pittet E, Staehli DM, Clerc O, Kenfak AF, et al. Urinary culture sensitivity after a single empirical antibiotic dose for upper or febrile urinary tract infection: A prospective multicentre observational study. Clin Microbiol Infect. 2022;28(8):1099-104.  https://doi.org/10.1016/j.cmi.2022.02.044  PMID: 35289297 
  25. Martelius T, Jalava J, Kärki T, Möttönen T, Ollgren J, Lyytikäinen O, Hospital Infection Surveillance team. Nosocomial bloodstream infections caused by Escherichia coli and Klebsiella pneumoniae resistant to third-generation cephalosporins, Finland, 1999-2013: Trends, patient characteristics and mortality. Infect Dis (Lond). 2016;48(3):229-34.  https://doi.org/10.3109/23744235.2015.1109135  PMID: 26577519 
  26. Arcilla MS, Van Hattem JM, Bootsma MCJ, van Genderen PJJ, Goorhuis A, Grobusch MP, et al. Prevalence and risk factors for carriage of ESBL-producing Enterobacteriaceae in a population of Dutch travellers: A cross-sectional study. Travel Med Infect Dis. 2020;33:101547.  https://doi.org/10.1016/j.tmaid.2019.101547  PMID: 31862246 
  27. Frost I, Van Boeckel TP, Pires J, Craig J, Laxminarayan R. Global geographic trends in antimicrobial resistance: the role of international travel. J Travel Med. 2019;26(8):1-13.  https://doi.org/10.1093/jtm/taz036  PMID: 31115466 
  28. Laupland KB, Church DL, Vidakovich J, Mucenski M, Pitout JDD. Community-onset extended-spectrum β-lactamase (ESBL) producing Escherichia coli: importance of international travel. J Infect. 2008;57(6):441-8.  https://doi.org/10.1016/j.jinf.2008.09.034  PMID: 18990451 
  29. Kantele A, Lääveri T, Mero S, Vilkman K, Pakkanen SH, Ollgren J, et al. Antimicrobials increase travelers’ risk of colonization by extended-spectrum betalactamase-producing Enterobacteriaceae. Clin Infect Dis. 2015;60(6):837-46.  https://doi.org/10.1093/cid/ciu957  PMID: 25613287 
  30. Arcilla MS, van Hattem JM, Haverkate MR, Bootsma MCJ, van Genderen PJJ, Goorhuis A, et al. Import and spread of extended-spectrum β-lactamase-producing Enterobacteriaceae by international travellers (COMBAT study): a prospective, multicentre cohort study. Lancet Infect Dis. 2017;17(1):78-85.  https://doi.org/10.1016/S1473-3099(16)30319-X  PMID: 27751772 
  31. Kurittu P, Khakipoor B, Jalava J, Karhukorpi J, Heikinheimo A. Whole-Genome Sequencing of Extended-Spectrum Beta-Lactamase-Producing Escherichia coli From Human Infections in Finland Revealed Isolates Belonging to Internationally Successful ST131-C1-M27 Subclade but Distinct From Non-human Sources. Front Microbiol. 2022;12:789280.  https://doi.org/10.3389/fmicb.2021.789280  PMID: 35058905 
  32. Koukkari K, Ollgren J, Ilmavirta H, Cristea V, Voipio T. Mikrobilääkekulutus Suomessa 2013-2020. [Antimicrobial consumption in Finland 2013-2020]. Helsinki: Finnish Institute for Health and Welfare (THL); 2021. Finnish. Available from: https://urn.fi/URN:ISBN:978-952-343-761-6
  33. Gladstone RA, McNally A, Pöntinen AK, Tonkin-Hill G, Lees JA, Skytén K, et al. Emergence and dissemination of antimicrobial resistance in Escherichia coli causing bloodstream infections in Norway in 2002-17: a nationwide, longitudinal, microbial population genomic study. Lancet Microbe. 2021;2(7):e331-41.  https://doi.org/10.1016/S2666-5247(21)00031-8  PMID: 35544167 

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