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(25 µg), amoxycillin-clavulanic acid (30 µg), cephalexin (30 µg) cefuroxime (30 µg) cefotaxime (30 µg) cotrimoxazole (1.25-23.75 µg), nalidixic acid (30 µg), ciprofloxacin (5 µg), tetracycline (30 IU), amikacin (30 µg), gentamicin (30 µg) and nitrofurantoin (300 µg). We measured resistance to cefpodoxime (10 µg) by disk diffusion, which has been studied as a screening method for ESBL production using a sensitivity break point of ≤21 mm. 3 The Epsilometer test (E-test) method was used for confirmation of ESBL production (AB Biodisk, Solna, Sweden). The strips were used according to the manufacturer’s instructions. A ratio of 8 or greater for the ceftazidime to ceftazidime-clavulanic acid minimal inhibitory concentrations (MICs) and the cefotaxime to cefotaxime-clavulanic acid MICs was considered ESBLpositive. 11 The E-test was also used for determining the MIC values of the antimicrobial agents used in this study. The quality control check was performed once weekly, using the reference strains E. coli ATCC 25 922 and a betalactamase-producing E. coli ATCC 35 218 to check the results of disks that contain a combination of beta-lactam antibiotics and a beta-lactamase inhibitor. Results

Extended spectrum beta-lactamases inEschericia coliisolated from community-acquired urinary tract infections in the Gaza Strip, Palestine