title: Infections caused by carbapenem-resistant Gram-negative pathogens in hospitalized children.
abstract: BACKGROUND
  Carbapenem-resistant Gram-negative pathogens (CRPs) are emerging as major causes of nosocomial infections that increase morbidity, mortality and healthcare costs. Little is known about CRP infections in children.
  
  
  METHODS
  All newly detected infections caused by carbapenem-resistant Klebsiella spp, Pseudomonas spp or Acinetabocater spp in hospitalized patients are prospectively reported to the Hellenic Center for Disease Control and Prevention. All children <15 years old with a CRP infection reported from November 1, 2010, through March 30, 2012, were included in this study.
  
  
  RESULTS
  Between November 2010 and March 2012, 71 CRP infections in 65 children (median age: 1 year) were reported. Underlying conditions existed in 50 (76.9%) children. Cases included pneumonia (25 [35.2%], including 20 ventilator-associated pneumonias), bacteremia (32.4%), urinary tract infection (19.7%) and surgical site infection (12.7%). Isolates were Pseudomonas spp (41.1%), Acinetobacter spp (39.7%) and Klebsiella spp (19.2%). The first positive culture occurred a median of 20 days (range: 0-313 days) after admission. Twenty-four (33.8%) infections occurred in patients with a history of hospitalization the previous 6 months; 42 (59.2%) and 36 (50.7%) infections occurred among patients who had received broad-spectrum antibiotics including carbapenems the previous 6 months, respectively. The crude mortality at 28 days after the first positive CRP culture was 21.1%.
  
  
  CONCLUSIONS
  Infections caused by CRPs among children are associated with significant morbidity and mortality.
authors.affiliation: Department for Interventions in Health-Care Facilities, Hellenic Center for Disease Control and Prevention, Athens, Greece. jannaterschure@gmail.com
authors.forename: Helena C
authors.initials: HC
authors.lastname: Maltezou
authors.forename: Flora
authors.initials: F
authors.lastname: Kontopidou
authors.forename: Panos
authors.initials: P
authors.lastname: Katerelos
authors.forename: George
authors.initials: G
authors.lastname: Daikos
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Roilides
authors.forename: Maria
authors.initials: M
authors.lastname: Theodoridou
mesh_terms: D000150:Acinetobacter / Q000187:drug effects / Q000302:isolation & purification; D000151:Acinetobacter Infections / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality / Q000473:pathology; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D015780:Carbapenems / Q000494:pharmacology*; D002648:Child; D002673:Child, Hospitalized; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality / Q000473:pathology; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007709:Klebsiella / Q000187:drug effects / Q000302:isolation & purification; D007710:Klebsiella Infections / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality / Q000473:pathology; D008297:Male; D011549:Pseudomonas / Q000187:drug effects / Q000302:isolation & purification; D011552:Pseudomonas Infections / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality / Q000473:pathology; D016019:Survival Analysis; D018440:beta-Lactam Resistance
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems