title: Persistence of Klebsiella pneumoniae ST258 as the predominant clone of carbapenemase-producing Enterobacteriaceae in post-acute-care hospitals in Israel, 2008-13.
abstract: OBJECTIVE
  To study the molecular characteristics of carbapenemase-producing Enterobacteriaceae (CPE) in post-acute-care hospitals (PACHs) in Israel and to analyse the temporal changes between 2008 and 2013.
  
  
  METHODS
  CPE isolates were obtained during two cross-sectional, point prevalence national surveys of PACHs in Israel performed in 2008 and 2013. Surveillance cultures were collected by streaking rectal swabs onto selective media. Isolates were identified to species level and tested for blaKPC, blaNDM and blaOXA-48 by PCR and by the Carba NP test. Molecular typing was done by PCR for the pilv-l gene, designed for the ST258 KPC-producing Klebsiella pneumoniae (KPC-KP) clone, BOX-PCR and MLST.
  
  
  RESULTS
  The prevalence of CPE carriage in the first survey was 184/1147 (16%); all of the isolates were KPC-KP. The prevalence of CPE carriage in the second survey was 127/1287 (9.9%); of these isolates, 113 (89%) were KPC-KP, 9 (7%) were other KPC-producing species and 5 (4%) were NDM- and OXA-48-producing CPE (n = 1 and 4, respectively). The proportion of the KPC-KP population represented by the ST258 clone increased from 120/184 (65%) in 2008 to 91/113 (80%) in 2013. In 58% (71/122) of the KPC-CPE carriers identified in the 2013 survey, the source of acquisition was determined to be the PACH itself. All four OXA-48 CPE were acquired either directly or indirectly from patients arriving from the Palestinian Authority or Syria.
  
  
  CONCLUSIONS
  Despite the decreased prevalence of CPE in Israeli PACHs, and the emergence of new types of CPE, the KPC-KP ST258 clone remains the predominant clone represented.
authors.affiliation: National Center for Infection Control, Tel Aviv, Israel (affiliated with the Sackler School of Medicine, Tel Aviv University) amosa@tlvmc.gov.il.
authors.forename: Amos
authors.initials: A
authors.lastname: Adler
authors.affiliation: National Center for Infection Control, Tel Aviv, Israel (affiliated with the Sackler School of Medicine, Tel Aviv University).
authors.forename: Omar
authors.initials: O
authors.lastname: Hussein
authors.affiliation: National Center for Infection Control, Tel Aviv, Israel (affiliated with the Sackler School of Medicine, Tel Aviv University).
authors.forename: Debby
authors.initials: D
authors.lastname: Ben-David
authors.affiliation: National Center for Infection Control, Tel Aviv, Israel (affiliated with the Sackler School of Medicine, Tel Aviv University).
authors.forename: Samira
authors.initials: S
authors.lastname: Masarwa
authors.affiliation: National Center for Infection Control, Tel Aviv, Israel (affiliated with the Sackler School of Medicine, Tel Aviv University) Department of Molecular Biology, Faculty of Natural Sciences, Ariel University, Ariel, Israel.
authors.forename: Shiri
authors.initials: S
authors.lastname: Navon-Venezia
authors.affiliation: National Center for Infection Control, Tel Aviv, Israel (affiliated with the Sackler School of Medicine, Tel Aviv University).
authors.forename: Mitchell J
authors.initials: MJ
authors.lastname: Schwaber
authors.affiliation: National Center for Infection Control, Tel Aviv, Israel (affiliated with the Sackler School of Medicine, Tel Aviv University).
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Carmeli
mesh_terms: D001426:Bacterial Proteins / Q000378:metabolism*; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology*; D003430:Cross-Sectional Studies; D004756:Enterobacteriaceae Infections / Q000453:epidemiology / Q000382:microbiology*; D005838:Genotype; D006761:Hospitals; D006801:Humans; D007557:Israel; D007711:Klebsiella pneumoniae / Q000145:classification* / Q000201:enzymology* / Q000302:isolation & purification; D017720:Molecular Epidemiology; D058889:Molecular Typing; D015995:Prevalence; D012189:Retrospective Studies; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D001426:Bacterial Proteins; D001618:beta-Lactamases; C063912:carbapenemase
keywords: KPC; clonal structure; colonization