None of the isolates investigated tested positive for bla- PER- like, bla ACC- like, bla VEB- like , or bla DHA- like genes. Distribution of bla genes We also analyzed for the distribution of bla genes among ITF2357 mouse strains obtained from different specimen-types and among those obtained from hospitalized and Smoothened inhibitor non-hospitalized patients, Figure 1. Majority of bla genes were present in all specimen-types regardless of their clinical backgrounds. However, bla CTX-M-3 was only detected in isolates from urine while bla TEM-78 was not detected among isolates from blood.

bla TEM-109 and bla CTX-M-8 on the other hand, were exclusively detected among isolates obtained from hospitalized patients. All bla genes described in this study were found in isolates obtained from both the 1990s and 2000s except bla CMY-1 that was exclusively detected among isolates obtained during the 2000–2010 period. Figure 1 Occurrence of  bla  genes among isolates from different clinical backgrounds. 1a: Occurrence of bla genes among isolates from blood, stool and urine, 1b: Occurrence of bla genes among isolates from inpatient and outpatient populations: 1c: Occurrence of bla genes among isolates obtained in the 1990s and 2000s periods. Discussion In this

study, we describe the diversity of β-lactamase genes in a large collection of E. coli from different types of clinical specimen obtained from hospitalized and non-hospitalized VX-689 purchase patients in Kenya. This study suggests that carbapenems and to a less extent, cefepime,

cephamycins and piperacillin-tazobactam may still be potent against majority of the isolates investigated. Although we do not rule out that the panel of bla genes in our strains is wider than what is reported in this study, there was a general agreement between phenotypic data and the panel of bla genes detected in the strains analysed. The diversity of bla genes encountered in isolates from blood, stool and urine specimen of hospitalized patients was almost identical to the panel of genes encountered nearly in corresponding specimens from non-hospitalized patients. This partially suggests a possible exchange of strains between hospitalized and non-hospitalized patients or a flow of genes among strains from different clinical backgrounds. Based on the resistance profiles, we identify ESBL-, CMT- and pAmpC-producers as the most important set of strains whose spread in hospital and community settings should be closely monitored. If the prevalence of isolates with such highly resistant strains continues to rise, majority of β-lactam antibiotics may cease to be effective agents for management of community- and hospital-acquired infections in Kenya.