Detection and characterization of carbapenemase-producing Enterobacteriaceae in wounded Syrian patients admitted to hospitals in northern Israel

• Published in: European journal of clinical microbiology & infectious diseases Vol. 35; no. 1; pp. 149 - 154
• Main Authors: Lerner, A., Solter, E., Rachi, E., Adler, A., Rechnitzer, H., Miron, D., Krupnick, L., Sela, S., Aga, E., Ziv, Y., Peretz, A., Labay, K., Rahav, G., Geffen, Y., Hussein, K., Eluk, O., Carmeli, Y., Schwaber, M. J.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 2016; Springer Nature B.V
• Subjects: Adolescent; Adult; Bacterial Proteins - genetics; Bacterial Typing Techniques; beta-Lactamases - genetics; Biomedical and Life Sciences; Biomedicine; Disease control; E coli; Enterobacteriaceae - classification; Enterobacteriaceae - enzymology; Enterobacteriaceae - genetics; Enterobacteriaceae - isolation & purification; Enterobacteriaceae Infections - microbiology; Female; Genotype; Health care; Hospitalization; Hospitals; Humans; Infectious diseases; Internal Medicine; Israel; Laboratories; Male; Medical Microbiology; Middle Aged; Multilocus Sequence Typing; Original Article; Polymerase Chain Reaction; Public health; Staphylococcus infections; Syria; Warfare; Wound Infection - microbiology; Young Adult; Tel Aviv Israel; Syria; Israel; Meropenem; Medical Tourism; Colistin; Tigecycline; Fosfomycin
• ISSN: 0934-9723; 1435-4373
• DOI: 10.1007/s10096-015-2520-9

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.