Incidence of community-onset extended-spectrum β-lactamase-producing and infections: an 11-year population-based study in Denmark.

Data elucidating trends of community-onset extended-spectrum β-lactamase (ESBL)-producing and infections remain sparse in low prevalence areas. We conducted a population-based study to determine the incidence, temporal trends and co-resistance of community-onset ESBL infections. We identified all recorded episodes of and bacteraemia and urinary tract infections in adult patients (>15 years) in the North Denmark Region between 2007-2017. Using population-based registries, we obtained information on demographics and place of acquisition, and investigated the standardized incidence rates and temporal trends of community-onset ESBL infections and the associated patterns of co-resistance. A total of 3741 episodes of community-onset ESBL or infections were observed during the study period, with the annual standardized incidence rate increasing from 7.5 to 105 per 100,000 person-years between 2007-2017. The increase was conveyed primarily by a rise in urinary tract infections shifting from being mainly healthcare-associated to community-acquired. ESBL-producing isolates increased from 0.5 to 4.0% with considerable co-resistance. The proportion of and isolates producing ESBL have increased considerably in the North Denmark Region. The increasing incidence and frequent co-resistance should raise awareness among physicians responsible for empirical antibiotic treatment.