Objectives: We aimed to study the molecular characteristics of carbapenemase-producing Enterobacteriaceae (CPE) in post-acute care hospitals (PACHs) in Israel and to analyze the temporal changes between 2008 and 2013.
Methods: CPE isolates were obtained during two cross-sectional, point prevalence national surveys of PACH`s in Israel performed in 2008 and 2013. Surveillance cultures were collected by rectal swab streaked onto selective media. Isolates were identified to the 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 sequence-type (ST)-258 KPC-producing Klebsiella pneumoniae (KPC-KP) clone, BOX-PCR and MLST.
Results: The prevalence of CPE carriage in the first survey was 184/1,147 (16 %) all isolates KPC-KP. The prevalence of CPE carriage in the second survey was 127/1,287 (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 ST-258 clone increased from 120/184 (65%) in 2008 to 91/113 (80%) in 2013. In 68% (83/122) of the KPC-CPE carriers identified in the 2013 survey, the source of acquisition was determined to be the PACH itself. All 4 OXA-48 CPE`s 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, KPC-KP ST-258 clone remains the predominant clone represented.
