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

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          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.

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          Author and article information

          Journal
          Eur. J. Clin. Microbiol. Infect. Dis.
          European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology
          Springer Nature
          1435-4373
          0934-9723
          Jan 2016
          : 35
          : 1
          Affiliations
          [1 ] National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel. anatle@tlvmc.gov.il.
          [2 ] Reference Laboratory, National Center for Infection Control, 6 Weizmann St., Tel Aviv, 6423906, Israel. anatle@tlvmc.gov.il.
          [3 ] Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. anatle@tlvmc.gov.il.
          [4 ] National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel.
          [5 ] Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
          [6 ] Reference Laboratory, National Center for Infection Control, 6 Weizmann St., Tel Aviv, 6423906, Israel.
          [7 ] Department of Infectious Disease Consultation Service, Ziv Medical Center, Safed, Israel.
          [8 ] Faculty of Medicine in the Galilee, Bar-Ilan University, Ramat Gan, Israel.
          [9 ] Infectious Disease Unit, Galilee Medical Center, Nahariya, Israel.
          [10 ] Infectious Disease Unit, Baruch Padeh Medical Center, Poriya, Israel.
          [11 ] Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel.
          [12 ] Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
          Article
          10.1007/s10096-015-2520-9
          10.1007/s10096-015-2520-9
          26581423

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