title: A multicenter study of the clonal structure and resistance mechanism of KPC-producing Escherichia coli isolates in Israel.
abstract: Little is known about the molecular epidemiology of Klebsiella pneumoniae carbapenemase-producing Escherichia coli (KPCEC). We aimed to describe the clonal structure and resistance mechanisms of KPCEC in a multicenter study. The study included 88 isolates from four medical centres in Israel: Tel Aviv Medical Center (n = 17), Laniado Medical Center (n = 12), Sha'are-Zedek Medical Center (n = 38), and Rambam Medical Center (n = 21). Twelve (14%) KPCEC were from clinical sites and 86% from surveillance cultures. The clonal structure was studied by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) and was highly diverse, with 79 and 45 different PFGE types and STs, respectively. The most common clones were ST-131 and ST-410, identified in 21 isolates (23%). Dominant clonal complexes (CCs) were CC131 (n = 16), CC410 (n = 14), CC10 (n = 17), and CC-69 (n = 6). The blaKPC-2 and blaKPC-3 genes were identified in 68 and 20 isolates, respectively. All isolates were non-susceptible to ertapenem; 16 (18%) and 35 (40%) isolates were susceptible (minimal inhibitory concentration ≤1 mg/L) to imipenem and meropenem, respectively. Isolates were susceptible to colistin, amikacin, ciprofloxacin, gentamicin, and trimethoprim-sulfamethoxazole in 100%, 87%, 28%, 27%, and 21% of the cases, respectively. blaKPC-Harbouring plasmids from Tel Aviv Medical Center as well as from six CC-131 isolates from the other centres were studied by Inc and pMLST typing. Sixteen of the 20 blaKPC2-harbouring plasmids were of identical type, IncN-pMLST ST-15. In conclusion, the clonal structure of KPCEC in Israel is characterized by the predominance of known international extended-spectrum β-lactamase-producing clones and by high intra- and inter-institutional diversity. This suggests that in Israel, clonal spread does not play a major role in the dissemination of KPCEC.
authors: National Center for Infection Control, Ministry of Health, Tel Aviv, Israel; Division of Epidemiology, Tel Aviv Sourasky Medical Center, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: amosa@tlvmc.gov.il.
authors: A
authors: A
authors: Adler
authors: National Center for Infection Control, Ministry of Health, Tel Aviv, Israel; Division of Epidemiology, Tel Aviv Sourasky Medical Center, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors: T
authors: T
authors: Miller-Roll
authors: Microbiology and Immunology Laboratory, Sha'are-Zedek Medical Center, Jerusalem, Israel.
authors: M V
authors: MV
authors: Assous
authors: Microbiology Laboratory, Rambam Medical Center, Haifa, Israel.
authors: Y
authors: Y
authors: Geffen
authors: Division of Laboratories, Laniado Medical Center, Netanya, Israel.
authors: S
authors: S
authors: Paikin
authors: Microbiology Laboratory, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
authors: D
authors: D
authors: Schwartz
authors: Section of Infectious Diseases, Shaare-Zedek Medical Center, Jerusalem, Israel.
authors: Y
authors: Y
authors: Weiner-Well
authors: Section of Infectious Diseases, Rambam Medical Center, Haifa, Israel.
authors: K
authors: K
authors: Hussein
authors: Section of Infectious Diseases, Laniado Medical Center, Netanya, affiliated with the Faculty of Medicine, Technion Institute of Technology, Haifa, Israel.
authors: R
authors: R
authors: Cohen
authors: National Center for Infection Control, Ministry of Health, Tel Aviv, Israel; Division of Epidemiology, Tel Aviv Sourasky Medical Center, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors: Y
authors: Y
authors: Carmeli
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D004926:Escherichia coli / Q000145:classification / Q000187:drug effects / Q000235:genetics* / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000453:epidemiology* / Q000382:microbiology*; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008826:Microbial Sensitivity Tests; D058885:Multilocus Sequence Typing; D010957:Plasmids / Q000235:genetics; D012189:Retrospective Studies; D017422:Sequence Analysis, DNA; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000235:genetics*
chemical_list: D000900:Anti-Bacterial Agents; D001618:beta-Lactamases
keywords: Clonal structure; E. coli; KPC-carbapenemase; plasmids; transmission