title: Emergence of carbapenem-resistant Enterobacteriaceae in a UK paediatric hospital.
abstract: BACKGROUND
  Carbapenem-resistant Enterobacteriaceae are an emerging global infection threat. However, there are few data describing their clinical importance in children.
  
  
  OBJECTIVE
  This retrospective study reviewed the prevalence and resistance mechanisms of carbapenem-resistant Enterobacteriaceae grown from clinical and surveillance samples in a large tertiary referral children's hospital in the UK.
  
  
  METHODS
  Carbapenem-resistant Enterobacteriaceae were sought in specimens submitted for diagnostic and surveillance purposes at Alder Hey Children's NHS Foundation Trust, Liverpool, between September 2011 and August 2012. Mechanisms of resistance were identified using phenotypic and/or molecular methods. Variable number tandem repeat profiling was used to type carbapenemase-producing strains.
  
  
  RESULTS
  During the 12-month study period, carbapenem-resistant Enterobacteriaceae were recovered from 24 patients. Five isolates were from clinical diagnostic specimens whereas 19 of 421 patients had positive rectal surveillance swabs (4.5%). Of the 24 isolates, seven (all Klebsiella spp.) harboured carbapenemases: three had blaKPC and four blaNDM, whereas 17 had resistance due to combinations of AmpC or extended-spectrum β-lactamase activity plus impermeability.
  
  
  CONCLUSIONS
  Carbapenem-resistant Enterobacteriaceae and, in particular, those with carbapenemases, are an emerging infection problem in a major paediatric hospital in the UK. Active surveillance is required to monitor and control their spread.
authors.affiliation: Department of Microbiology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK. Richard.drew@alderhey.nhs.uk
authors.forename: R J
authors.initials: RJ
authors.lastname: Drew
authors.forename: J F
authors.initials: JF
authors.lastname: Turton
authors.forename: R L R
authors.initials: RL
authors.lastname: Hill
authors.forename: D M
authors.initials: DM
authors.lastname: Livermore
authors.forename: N
authors.initials: N
authors.lastname: Woodford
authors.forename: S
authors.initials: S
authors.lastname: Paulus
authors.forename: N A
authors.initials: NA
authors.lastname: Cunliffe
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D015780:Carbapenems / Q000494:pharmacology*; D002648:Child; D002675:Child, Preschool; D021821:Communicable Diseases, Emerging / Q000453:epidemiology* / Q000382:microbiology*; D004755:Enterobacteriaceae / Q000187:drug effects* / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008826:Microbial Sensitivity Tests; D018598:Minisatellite Repeats; D058889:Molecular Typing; D016133:Polymerase Chain Reaction; D015995:Prevalence; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D006113:United Kingdom / Q000453:epidemiology; D018440:beta-Lactam Resistance
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems
keywords: Antimicrobial resistance; Carbapenemases; KPC; NDM