title: The occurrence of Enterobacteriaceae producing KPC carbapenemases in a general hospital in Curacao.
abstract: BACKGROUND
  Although the presence of Carbapenemase-producing Enterobacteriaceae (CPE) are extensively documented in North and South America. CPE have not been reported from Curacao. However, recently intercontinental spread was suggested of a KPC carbapenemase producing Klebsiella pneumoniae in a patient in the United Kingdom with previous admission to a hospital in Curacao in 2009.
  
  
  RESULTS
  After the introduction of the CLSI 2010 revised breakpoints, seven patients with carbapenemase-producing Enterobacteriaceae were found in a general hospital in Curacao over a period of 16 months. Four patients carried KPC-2 positive Klebsiella pneumoniae, ST11. Two patients carried KPC-3 positive Klebsiella pneumoniae ST258 and one patient carried a KPC-3 positive Citrobacter freundii. Furthermore, our Klebsiella pneumoniae KPC-2 ST11 strain was matched to the Klebsiella pneumoniae KPC-2 ST11 strain in the United Kingdom.
  
  
  CONCLUSIONS
  Introduction of new laboratory methods, and adoption of new guidelines and breakpoints led to the first detection of CPE in Curacao. By matching our Klebsiella pneumoniae KPC-2 ST11 strain to a Klebsiella pneumoniae KPC-2 ST11 strain in the United Kingdom, we suggest that carbapenemase-producing Enterobacteriaceae are probably more prevalent in Curacao than previously recognized.
authors.affiliation: Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands ; Department of Medical Microbiology, Maastricht University Medical Centre, PO Box 5800, Maastricht 6202 AZ, The Netherlands.
authors.forename: Sandra
authors.initials: S
authors.lastname: Erkens-Hulshof
authors.affiliation: Analytical Diagnostic Centre, National Laboratory, Willemstad, Curacao, Netherlands Antilles.
authors.forename: Liane
authors.initials: L
authors.lastname: Virginia-Cova
authors.affiliation: Department of Hygiene Infection Control, St. Elisabeth Hospital, Willemstad, Curacao, Netherlands Antilles.
authors.forename: Willemien
authors.initials: W
authors.lastname: van Dijk
authors.affiliation: Department of Medical Microbiology and Infectious Diseases Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
authors.forename: Juliette
authors.initials: J
authors.lastname: Severin
authors.affiliation: Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, Public Health England, London, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Woodford
authors.affiliation: Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Willem
authors.initials: W
authors.lastname: Melchers
authors.affiliation: Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Patrick
authors.initials: P
authors.lastname: Sturm
keywords: Carbapenemases; Enterobacteriaceae; KPC