title: Detection and characterization of carbapenemase-producing Enterobacteriaceae in wounded Syrian patients admitted to hospitals in northern Israel.
abstract: Since 2013, four hospitals in northern Israel have been providing care for Syrian nationals, primarily those wounded in the ongoing civil war. We analyzed carbapenemase-producing Enterobacteriaceae (CPE) isolates obtained from these patients. Isolate identification was performed using the VITEK 2 system. Polymerase chain reaction (PCR) was performed for the presence of bla KPC, bla NDM, and bla OXA-48. Susceptibility testing and genotyping were performed on selected isolates. During the study period, 595 Syrian patients were hospitalized, most of them young men. Thirty-two confirmed CPE isolates were grown from cultures taken from 30 patients. All but five isolates were identified as Klebsiella pneumoniae and Escherichia coli. Nineteen isolates produced NDM and 13 produced OXA-48. Among a further 29 isolates tested, multilocus sequence typing (MLST) showed that ST278 and ST38 were the major sequence types among the NDM-producing K. pneumoniae and OXA-48-producing E. coli isolates, respectively. Most were resistant to all three carbapenems in use in Israel and to gentamicin, but susceptible to colistin and fosfomycin. The source for bacterial acquisition could not be determined; however, some patients admitted to different medical centers were found to carry the same sequence type. CPE containing bla NDM and bla OXA-48 were prevalent among Syrian wounded hospitalized patients in northern Israel. The finding of the same sequence type among patients at different medical centers implies a common, prehospital source for these patients. These findings have implications for public health throughout the region.
authors.affiliation: National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel. anatle@tlvmc.gov.il.|Reference Laboratory, National Center for Infection Control, 6 Weizmann St., Tel Aviv, 6423906, Israel. anatle@tlvmc.gov.il.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. anatle@tlvmc.gov.il.
authors.forename: A
authors.initials: A
authors.lastname: Lerner
authors.affiliation: National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: E
authors.initials: E
authors.lastname: Solter
authors.affiliation: National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel.|Reference Laboratory, National Center for Infection Control, 6 Weizmann St., Tel Aviv, 6423906, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: E
authors.initials: E
authors.lastname: Rachi
authors.affiliation: National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel.|Reference Laboratory, National Center for Infection Control, 6 Weizmann St., Tel Aviv, 6423906, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Adler
authors.affiliation: Department of Infectious Disease Consultation Service, Ziv Medical Center, Safed, Israel.|Faculty of Medicine in the Galilee, Bar-Ilan University, Ramat Gan, Israel.
authors.forename: H
authors.initials: H
authors.lastname: Rechnitzer
authors.affiliation: Department of Infectious Disease Consultation Service, Ziv Medical Center, Safed, Israel.|Faculty of Medicine in the Galilee, Bar-Ilan University, Ramat Gan, Israel.
authors.forename: D
authors.initials: D
authors.lastname: Miron
authors.affiliation: Department of Infectious Disease Consultation Service, Ziv Medical Center, Safed, Israel.|Faculty of Medicine in the Galilee, Bar-Ilan University, Ramat Gan, Israel.
authors.forename: L
authors.initials: L
authors.lastname: Krupnick
authors.affiliation: Infectious Disease Unit, Galilee Medical Center, Nahariya, Israel.|Faculty of Medicine in the Galilee, Bar-Ilan University, Ramat Gan, Israel.
authors.forename: S
authors.initials: S
authors.lastname: Sela
authors.affiliation: Infectious Disease Unit, Galilee Medical Center, Nahariya, Israel.|Faculty of Medicine in the Galilee, Bar-Ilan University, Ramat Gan, Israel.
authors.forename: E
authors.initials: E
authors.lastname: Aga
authors.affiliation: Infectious Disease Unit, Galilee Medical Center, Nahariya, Israel.|Faculty of Medicine in the Galilee, Bar-Ilan University, Ramat Gan, Israel.
authors.forename: Y
authors.initials: Y
authors.lastname: Ziv
authors.affiliation: Infectious Disease Unit, Baruch Padeh Medical Center, Poriya, Israel.|Faculty of Medicine in the Galilee, Bar-Ilan University, Ramat Gan, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Peretz
authors.affiliation: Infectious Disease Unit, Baruch Padeh Medical Center, Poriya, Israel.|Faculty of Medicine in the Galilee, Bar-Ilan University, Ramat Gan, Israel.
authors.forename: K
authors.initials: K
authors.lastname: Labay
authors.affiliation: Infectious Disease Unit, Baruch Padeh Medical Center, Poriya, Israel.|Faculty of Medicine in the Galilee, Bar-Ilan University, Ramat Gan, Israel.
authors.forename: G
authors.initials: G
authors.lastname: Rahav
authors.affiliation: Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel.|Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
authors.forename: Y
authors.initials: Y
authors.lastname: Geffen
authors.affiliation: Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel.|Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
authors.forename: K
authors.initials: K
authors.lastname: Hussein
authors.affiliation: Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel.|Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
authors.forename: O
authors.initials: O
authors.lastname: Eluk
authors.affiliation: National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Y
authors.initials: Y
authors.lastname: Carmeli
authors.affiliation: National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: M J
authors.initials: MJ
authors.lastname: Schwaber
mesh_terms: D000293:Adolescent; D000328:Adult; D001426:Bacterial Proteins / Q000235:genetics*; D015373:Bacterial Typing Techniques; D004755:Enterobacteriaceae / Q000145:classification / Q000201:enzymology* / Q000235:genetics / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000382:microbiology*; D005260:Female; D005838:Genotype; D006761:Hospitals; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D058885:Multilocus Sequence Typing; D016133:Polymerase Chain Reaction; D013593:Syria; D014857:Warfare; D014946:Wound Infection / Q000382:microbiology*; D055815:Young Adult; D001618:beta-Lactamases / Q000235:genetics*
chemical_list: D001426:Bacterial Proteins; D001618:beta-Lactamases; C063912:carbapenemase