Y Carmeli

Publications (72)361.63 Total impact

• Article: Outbreak of multidrug-resistant Pseudomonas aeruginosa infection following urodynamic studies traced to contaminated transducer.

  E Bilavsky, I Pfeffer, J Tarabeia, V Schechner, J Abu-Hanna, G Grisaru-Soen, D Schwartz, S Navon-Venezia, Y Carmeli
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  ABSTRACT: We report a nosocomial outbreak of urinary tract infection by extremely drug resistant Pseudomonas aeruginosa, susceptible only to colistin. Infection in three patients followed urodynamic studies. Two of the three patients were children, one of whom also developed urosepsis. The investigation led to detection of contaminated pressure transducers. Genotyping confirmed that patient and transducer isolates were identical. These transducers were not labelled as 'single use only' despite the possibility that contaminated urine may reflux and mix with the fluid in the device. The issue of re-usable versus single-use urodynamic devices is discussed.
  The Journal of hospital infection 02/2013; · 3.01 Impact Factor
• Article: Comparative population analysis of Klebsiella pneumoniae with extended-spectrum β-lactamases colonizing patients in rehabilitation centers in four countries.

  A Baraniak, R Izdebski, J Fiett, E Sadowy, A Adler, M Kazma, J Salomon, C Lawrence, A Rossini, A Salvia, [......], J Fierro, M Paul, Y Lerman, S Malhotra-Kumar, C Lammens, H Goossens, W Hryniewicz, C Brun-Buisson, Y Carmeli, M Gniadkowski
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  ABSTRACT: The international project MOSAR was conducted in five rehabilitation centers; patients were screened for rectal carriage of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae. Among 229 Klebsiella pneumoniae isolates four clonal groups (CG) or complexes (CC) prevailed: CG17 in France, CG101 in Italy, CG15 in Spain, and CC147 in Israel. ESBLs, mainly CTX-Ms, were produced by 226 isolates; three isolates expressed AmpC-like cephalosporinases. High genetic diversity of K. pneumoniae populations was observed, with specific characteristics at each center.
  Antimicrobial Agents and Chemotherapy 02/2013; · 4.84 Impact Factor
• Article: Rectal swabs are suitable for quantifying the carriage load of KPC-producing carbapenem-resistant Enterobacteriaceae (CRE).

  A Lerner, J Romano, I Chmelnitsky, S Navon-Venezia, R Edgar, Y Carmeli
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  ABSTRACT: It is more convenient and practical to collect rectal-swabs than stool specimens for studying carriage of colon pathogens. Herein we examined the ability to use rectal-swabs rather than stool specimens to quantify KPC-producing carbapenem-resistant Enterobacteriaceae (CRE). We used a qPCR assay to determine the concentration of bla(KPC) relative to 16S rDNA genes, and a quantitative culture-based method to quantify CRE relative to total aerobic bacteria. Our results demonstrated that rectal-swabs are suitable for quantifying the concentration of KPC-producing CRE and that qPCR showed higher correlation between rectal-swabs and stool compared to the culture-based method.
  Antimicrobial Agents and Chemotherapy 01/2013; · 4.84 Impact Factor
• Article: Gastrointestinal colonization by KPC-producing Klebsiella pneumoniae following hospital discharge: duration of carriage and risk factors for persistent carriage.

  N Feldman, A Adler, N Molshatzki, S Navon-Venezia, E Khabra, D Cohen, Y Carmeli
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  ABSTRACT: The natural history of KPC-producing Klebsiella pneumoniae (KPC KP) carriage is unknown. We aimed to examine the duration of KPC KP carriage following hospital discharge and to study the risk factors for persistent carriage. A cohort of 125 KPC KP carriers was followed monthly for between 3 and 6 months after discharge from an acute-care hospital. Rectal swabs and data were collected at baseline and at each visit. KPC KP was detected by culture and direct bla(KPC) PCR. Acquisition time was regarded as the earliest date of KPC KP isolation. Resolution of carriage was defined as a negative KPC KP test in at least two consecutive samples. Analyses were separated for recent (<4 months) (REC, 75 patients) and remote (≥4 months) (REM, 50 patients) acquisition groups. Risk factors for persistent carriage were examined by survival analyses for the REC group and by prevalence methods for the REM group. The mean age of patients was 67.5 years and 49.6% were male. Forty-six (61%) patients in the REC group and 14 (28%) in the REM group were persistent carriers (p < 0.001). A significant risk factor for persistent carriage identified in both the REC and REM groups was the presence of any catheter (p < 0.05). Unique risk factor groups included long-term care facility (LTCF) residence (p < 0.01) and a low functional status as measured by the Barthel's index (p < 0.05) in the REC group and high Charlson's score in the REM group (p < 0.05). Out of the entire 100 patients who had at least one negative sample, only 65 remained negative on subsequent cultures. In conclusion, persistent carriage of KPC KP is associated with catheter use and a low functional status; it is more common in patients with recent acquisition and is related to LTCF stay. A single negative KPC KP test is insufficient to exclude persistent carriage.
  Clinical Microbiology and Infection 11/2012; · 4.54 Impact Factor
• Article: The emergence and dissemination of CTX-M-producing Escherichia coli sequence type 131 causing community-onset bacteremia in Israel.

  D Karfunkel, Y Carmeli, I Chmelnitsky, T Kotlovsky, S Navon-Venezia
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  ABSTRACT: Community-onset bloodstream infections caused by extended-spectrum β-lactamase-producing Escherichia coli (ESBL-EC-COBSIs) were investigated over a 7-year-period (2003-2009) in our institution. ESBL-EC-COBSI inclusion criteria were cefotaxime/ceftazidime non-susceptible blood isolates recovered during 48 h upon hospital admission. Forty-one isolates were molecularly characterized. Susceptibilities were determined (Vitek-2) and genotyping was performed [multilocus sequence typing (MLST)]. CTX-M genes were determined [polymerase chain reaction (PCR) and sequencing] and bla (CTX-M)-encoding plasmids (n = 10) were analyzed and compared. Phylogrouping and virulence genes were identified (PCR). The incidence rate of ESBL-EC-COBSIs has increased from 2.94 to 7.87 cases/10,000 admissions. All isolates were multidrug-resistant (MDR), displaying co-resistance to ciprofloxacin (93 %), trimethoprim-sulfamethoxazole (85 %), and gentamicin (51 %). MLST identified ten sequence types (STs), of which five were novel. ST131 accounted for 66 % of the cases (27/41), and dominated over the years (prevalence of 25 % in 2003 and 85 % in 2009). All isolates carried CTX-M genes with the following prevalence: bla (CTX-M-2) (6/8; 75 %) in 2003; bla (CTX-M-15) (9/13, 69 % in 2007); and bla (CTX-M-15) (11/20, 55 %) and bla (CTX-M-14) (7/20, 35 %) in 2009. bla (CTX-M-15)- and bla (CTX-M-14)-encoding plasmids harbored by ST131 differed. Of all isolates, 98 % belonged to virulent phylogroups B2 (28/41, 68 %) and D (12/41, 29 %), though ST131 isolates carried a higher number of virulence genes compared to other lineages (p < 0.05). The incidence of ESBL-EC-COBSIs increased 2.7-fold during the period 2003-2009. This increase appears to be related to the emergence and clonal expansion of bla (CTX-M-15)- or bla (CTX-M-14)-carrying ST131. The superiority of this virulent lineage should be further explored.
  European Journal of Clinical Microbiology 11/2012; · 2.86 Impact Factor
• Article: Draft Genome Sequence of an Extremely Drug-Resistant KPC-Producing Klebsiella pneumoniae ST258 Epidemic Strain.

  I Chmelnitsky, T Doniger, M Shklyar, L Naparstek, E Banin, R Edgar, Y Carmeli
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  ABSTRACT: Extremely drug-resistant (XDR) Klebsiella pneumoniae carbapenemase-producing clone ST258 has rapidly disseminated worldwide. We report here the draft genome sequence of the K. pneumoniae ST258 XDR clinical strain from Israel.
  Journal of bacteriology 11/2012; 194(21):6014. · 3.94 Impact Factor
• Article: Environmental contamination by carbapenem-resistant Enterobacteriaceae (CRE).

  A Lerner, A Adler, J Abu-Hanna, I Meitus, S Navon-Venezia, Y Carmeli
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  ABSTRACT: In the last decade, the global emergence of carbapenem resistance in Enterobacteriaceae (CRE) has posed great concern to public health. Data concerning the role of environmental contamination in the dissemination of CRE is currently lacking. Here, we aimed to examine the extent of CRE contamination in various sites in the intimate surroundings of the CRE-carriers and to assess the effects of sampling time and cleaning regimens on the recovery rate. We evaluated the performance of two sampling methods, CHROMAgar KPC contact plate and eSwab for the detection of environmental CRE. eSwab was followed by either direct plating or by broth enrichment. First, fourteen sites in the close vicinity of the carrier were evaluated for environmental contamination, and 5 which were found to be contaminated, were further studied. The environmental contamination decreased with distant from the patient; bed area was the most contaminated site. Additionally, we found that the sampling time and the cleaning regimen were critical factors affecting the prevalence of environmental CRE contamination. We found that the CHROMAgar KPC contact plate method was more effective technique for detecting environmental CRE than eSwab-based methods. In summary, our study demonstrated that the vicinity of patients colonized with CRE is often contaminated by these organisms. Using selective contact plates to detect environmental contamination may guide cleaning efficacy and assist with outbreak investigation in an effort to limit the spread of CRE.
  Journal of clinical microbiology 10/2012; · 4.16 Impact Factor
• Article: Clonal structure, extended-spectrum β-lactamases and acquired AmpC-type cephalosporinases of Escherichia coli populations colonizing patients in rehabilitation centers in four countries.

  R Izdebski, A Baraniak, J Fiett, A Adler, M Kazma, J Salomon, C Lawrence, A Rossini, A Salvia, J Vidal Samso, J Fierro, M Paul, Y Lerman, S Malhotra-Kumar, C Lammens, H Goossens, W Hryniewicz, C Brun-Buisson, Y Carmeli, M Gniadkowski
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  ABSTRACT: The prospective project MOSAR was conducted in five rehabilitation units: BM (France), FS (Italy), GI (Spain), and LH and TA (Israel). Patients were screened for carriage of Enterobacteriaceae resistant to expanded-spectrum cephalosporins (ESCs) from admission until discharge. The aim of this study was to characterize clonal structure, and extended-spectrum β-lactamases (ESBLs) and acquired AmpC-like cephalosporinases in Escherichia coli populations collected. A total of 376 isolates were randomly selected. The overall number of sequence types (STs) was 76, including seven STs that grouped at least 10 isolates from at least three centers each, namely STs: 10, 38, 69, 131, 405, 410 and 648. These clones comprised 65.2% of all isolates, and ST131 alone - 41.2%. Of 54 STs observed only in one center, some STs played a locally significant role, like ST156 and ST393 in GI or ST372 and ST398 in TA. Among 16 new STs, five arose from the evolution within the ST10 and ST131 clonal complexes. ESBLs and AmpCs accounted for 94.7% and 5.6% of the ESC-hydrolyzing β-lactamases, respectively, being dominated by the CTX-M-like enzymes (79.9%), followed by SHV (13.5%) and CMY-2 (5.3%) types. CTX-M-15 was the most prevalent β-lactamase overall (40.6%); other ubiquitous enzymes were CTX-M-14 and CMY-2. Almost none of the common clones correlated strictly with one β-lactamase; although 58.7% of ST131 isolates produced CTX-M-15, the clone expressed also nine other enzymes. A number of clone variants with specific PFGE and ESBL types were spread in some locales, potentially representing newly emerging E. coli epidemic strains.
  Antimicrobial Agents and Chemotherapy 10/2012; · 4.84 Impact Factor
• Article: A binational cohort study of intestinal colonization with extended-spectrum β-lactamase-producing Proteus mirabilis in patients admitted to rehabilitation centres.

  A Adler, A Baraniak, R Izdebski, J Fiett, M Gniadkowski, W Hryniewicz, A Salvia, A Rossini, H Goossens, S Malhotra, Y Lerman, M Elenbogen, Y Carmeli
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  ABSTRACT: The aims of our study were to analyse the risk factors for colonization by Extended-spectrum β-lactamases (ESBL)-producing Proteus mirabilis (ESBL-PM) in rehabilitation patients and to characterize the molecular features of these strains. The study was conducted in two rehabilitation centres located in Rome, Italy (Fondazione Santa Lucia IRCCS (FSL)), and Tel-Aviv, Israel (Tel-Aviv Sourasky Medical Center (TASMC)). Carriage of ESBL-PM was surveyed by rectal swabs. Strain typing was performed by pulsed-field gel electrophoresis (PFGE). Identification of ESBL genes was done by PCR and sequencing. Patients admitted to the same institutions without ESBL carriage were included as controls. The study group included 70 and 41 patients from FSL and TASMC, respectively. In FSL, the multivariate analysis identified severe acute brain injury (OR = 15, 95% CI = 3.2-69.5, p 0.001), decubitus ulcer (OR = 3.5, 95% CI = 1.2-9.8, p 0.018) and recent treatment with quinolones (OR = 5.7, 95% CI = 1.07-30.1, p 0.042) as independent risk factors. ESBL-PM carriers stayed longer in the hospital on average and were less likely to be discharged home. No significant risk factor was identified in TASMC. There were no similarities in PFGE types or ESBL genes between the ESBL-PM isolates from the two institutions. In both hospitals, a variety of PFGE types existed but a single ESBL type predominated, namely TEM-92 in FSL (n = 64/70; 91%) and CTX-M-2 in TASMC (n = 37/41; 90%). A new TEM ESBL variant, TEM-177 was identified in FSL. The clonal diversity and the predominance of a single ESBL type suggested that horizontal gene transfer played an important role in dissemination of resistance. The development of a population analysis tool that would allow tracing deeper genetic relationships is required.
  Clinical Microbiology and Infection 10/2012; · 4.54 Impact Factor
• Article: Unique genes identified in the epidemic extremely drug-resistant KPC-producing Klebsiella pneumoniae sequence type 258.

  I Chmelnitsky, M Shklyar, O Hermesh, S Navon-Venezia, R Edgar, Y Carmeli
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  ABSTRACT: OBJECTIVES: A KPC-producing Klebsiella pneumoniae clone, sequence type (ST) 258, has emerged and spread worldwide. This study aimed to identify putative genes that may contribute to the extraordinary dissemination of the KPC-producing ST258 clone. METHODS: A suppressive subtractive hybridization (SSH) library was constructed using two KPC-producing strains: an epidemic ST258 and a non-epidemic ST376. The fragments obtained were sequenced, analysed and their presence among 27 additional ST258 isolates and 21 isolates of non-epidemic STs was determined. The functions of the putative proteins were extracted from NCBI databases. Localization to plasmid/chromosome was determined by PCR after transformation and by Southern hybridization. In silico homologues for the subtractive fragments were searched among sequences available in the NCBI database. RESULTS: SSH yielded 42 fragments (50 proteins) specific to the ST258 isolate tested, 30 of them located on various plasmids. The ST258 strains examined could be divided into two groups, one in which all 50 genes were ubiquitous and another group that lost 11 fragments, all located on one of the plasmids. This group of 50 genes was absent among other STs tested. Nineteen genes were unique to ST258 strains and 17 to CC258 (where CC stands for clonal complex). Most of the deduced proteins belonged to two major functional groups: 15 to the cell motility and secretion group, and 14 to the DNA repair and modification group. CONCLUSIONS: This study identifies unique genes in ST258 bacteria that may contribute to its epidemiological success as compared with other KPC-producing STs. Conservation of plasmid-encoded genes among ST258 isolates, despite plasmid variation, supports their importance in the success of this clone.
  Journal of Antimicrobial Chemotherapy 10/2012; · 5.07 Impact Factor
• Article: Transmission dynamics of ESBL-producing Escherichia coli clones in rehabilitation wards at a tertiary care centre.

  A Adler, M Gniadkowski, A Baraniak, R Izdebski, J Fiett, W Hryniewicz, S Malhotra-Kumar, H Goossens, C Lammens, Y Lerman, M Kazma, T Kotlovsky, Y Carmeli
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  ABSTRACT: Clin Microbiol Infect ABSTRACT: Increasing resistance due to the production of ESBL in Escherichia coli (ESBL-E. coli) has become a major threat to public health. Our aims were to study the incidence of ESBL-E. coli acquisition during hospitalization and the transmission rates of different ESBL-E. coli clones. This was a prospective case-control study, conducted in two geriatric rehabilitation wards in Tel-Aviv. Serial rectal cultures were collected from admission till discharge. All patient-unique ESBL-E. coli isolates were subjected to molecular typing by PFGE, MLST and determination of ESBL genes. An acquisition of ESBL-E. coli was defined as traceable when a patient with the same ST, PFGE type and ESBL gene was hospitalized in the same ward in parallel to the acquisition case. ESBL-E. colis were recovered from 125 patients out of 492 enrolled: 52 were recovered upon admission, 59 acquired ESBL-E. coli during their stay, and there was undetermined status in 14 patients. A low Norton's score was associated with acquisition (O.R. 1.14 for each point, 95% C.I. 1.01-1.29, p < 0.05). ESBL-E. coli infections (n = 9) had occurred only in ESBL-E. coli carriers. The pandemic ST131 clone was the most common (48/125). The majority of the isolates (101/125) produced CTX-M-type ESBL. Of the 59 acquisition cases, 32 were traced to another patient. In-hospital dissemination was highest in the CTX-M-27-producing ST131 and the SHV-5-producing ST372 sub-clones (acquisition/admission ratios of 17/11 and 9/3, respectively), with almost all cases traced to other patients. In conclusion, most ESBL-E. coli acquisition cases were traceable to other patients. The transmission potential varied significantly between ESBL-E. coli clones.
  Clinical Microbiology and Infection 07/2012; · 4.54 Impact Factor
• Article: Interventional strategies and current clinical experience with carbapenemase-producing Gram-negative bacteria.

  M Akova, G L Daikos, L Tzouvelekis, Y Carmeli
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  ABSTRACT: The wide dissemination of carbapenemase-producing Gram-negatives (CPGNs), including enterobacterial species and non-fermenters, has caused a public health crisis of global dimensions. These organisms cause serious infections in hospitalized patients, and are associated with increased mortality. Cross-transmission is common, and outbreaks may occur in healthcare facilities where the infection control practices are inadequate. CPGNs exhibit extensive drug-resistant phenotypes, complicate therapy, and limit treatment options. Systematic data on therapy are limited. However, regimens combining two or more active agents seem to be more efficacious than monotherapy in carbapenemase-producing Klebsiella pneumoniae infections. Strict infection control measures, including active surveillance for timely detection of colonized patients, separation of carriers from non-carriers, and contact precautions, are of utmost importance, and may be the only effective way of preventing the introduction and transmission of these bacteria in healthcare settings.
  Clinical Microbiology and Infection 05/2012; 18(5):439-48. · 4.54 Impact Factor
• Source

  Available from: Thierry Naas

  Article: Rapid evolution and spread of carbapenemases among Enterobacteriaceae in Europe.

  R Cantón, M Akóva, Y Carmeli, C G Giske, Y Glupczynski, M Gniadkowski, D M Livermore, V Miriagou, T Naas, G M Rossolini, Ø Samuelsen, H Seifert, N Woodford, P Nordmann
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  ABSTRACT: Plasmid-acquired carbapenemases in Enterobacteriaceae, which were first discovered in Europe in the 1990s, are now increasingly being identified at an alarming rate. Although their hydrolysis spectrum may vary, they hydrolyse most β-lactams, including carbapenems. They are mostly of the KPC, VIM, NDM and OXA-48 types. Their prevalence in Europe as reported in 2011 varies significantly from high (Greece and Italy) to low (Nordic countries). The types of carbapenemase vary among countries, partially depending on the cultural/population exchange relationship between the European countries and the possible reservoirs of each carbapenemase. Carbapenemase producers are mainly identified among Klebsiella pneumoniae and Escherichia coli, and still mostly in hospital settings and rarely in the community. Although important nosocomial outbreaks with carbapenemase-producing Enterobacteriaceae have been extensively reported, many new cases are still related to importation from a foreign country. Rapid identification of colonized or infected patients and screening of carriers is possible, and will probably be effective for prevention of a scenario of endemicity, as now reported for extended-spectrum β-lactamase (mainly CTX-M) producers in all European countries.
  Clinical Microbiology and Infection 05/2012; 18(5):413-31. · 4.54 Impact Factor
• Article: Asymptomatic rectal carriage of bla(KPC) producing carbapenem-resistant Enterobacteriaceae: who is prone to become clinically infected?

  V Schechner, T Kotlovsky, M Kazma, H Mishali, D Schwartz, S Navon-Venezia, M J Schwaber, Y Carmeli
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  ABSTRACT: Clin Microbiol Infect ABSTRACT: Carbapenem-resistant Enterobacteriaceae (CRE) are emerging extremely drug-resistant pathogens; bla(KPC) is the predominant carbapenemase in Israel. Early detection of asymptomatic rectal carriers is important for infection control purposes. We aimed to determine who among newly identified CRE rectal carriers is prone to have a subsequent clinical specimen with CRE. A matched case-control study was conducted in a tertiary care teaching hospital in Israel. Cases with a primary positive CRE rectal test and subsequent CRE clinical specimens were matched in a 1:2 ratio with CRE rectal carriers who did not develop subsequent CRE clinical specimens (controls). Matching was based on calendar time of primary CRE isolation, whether the primary CRE isolation was ≤48 h or >48 h after hospital admission, and time at risk to have a subsequent clinical specimen. Data were extracted from the patients' medical records and from the hospital's computerized database. One hundred and thirty-two newly identified CRE rectal carriers (44 cases, 88 controls) were included. The median time interval between screening and subsequent clinical specimens was 11 days (range, 3-27); 86% of the clinical specimens were classified as true infections. Independent predictors of subsequent CRE clinical specimens were: admission to the intensive care unit, having a central venous catheter, receipt of antibiotics, and diabetes mellitus. Identification of the risk factors for subsequent infections among CRE-colonized patients can be used to control modifiable risk factors and to direct empirical antimicrobial therapy when necessary.
  Clinical Microbiology and Infection 04/2012; · 4.54 Impact Factor
• Article: Reduced susceptibility to chlorhexidine among extremely-drug-resistant strains of Klebsiella pneumoniae.

  L Naparstek, Y Carmeli, I Chmelnitsky, E Banin, S Navon-Venezia
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  ABSTRACT: Over the last decade, extremely-drug-resistant (XDR) strains of Klebsiella pneumoniae have emerged worldwide, mainly as a result of patient-to-patient spread. The predominant clone, sequence type 258 (ST258), is associated with high morbidity and mortality, and is a worldwide threat to public health. It was hypothesized that reduced susceptibility to chlorhexidine, the most widely used hospital disinfectant, may contribute to the endemic nature of this strain. To characterize and compare the susceptibility of the epidemic K. pneumoniae clone ST258 and non-epidemic K. pneumoniae clones to chlorhexidine. The minimum inhibitory concentration (MIC) of chlorhexidine was determined in 126 XDR K. pneumoniae clinical isolates using agar dilution. Expression of three different efflux pumps -cepA, acrA and kdeA - was investigated in the absence and presence of chlorhexidine using quantitative real-time polymerase chain reaction. Heteroresistance to chlorhexidine was identified using population analysis. The MIC of chlorhexidine was higher for K. pneumoniae ST258 (N = 70) than other K. pneumoniae sequence types (N = 56); 99% of ST258 isolates had MICs >32 μg/mL, compared with 52% of other K. pneumoniae sequence types (P < 0.0001). Reduced susceptibility to chlorhexidine appeared to be independent of the expression of cepA, acrA and kdeA efflux pumps. Chlorhexidine-resistant subpopulations were observed independent of the bacterial sequence type or the MIC. Reduced susceptibility to chlorhexidine may contribute to the success of XDR K. pneumoniae as a nosocomial pathogen, and may provide a selective advantage to the international epidemic strain K. pneumoniae ST258. The heterogeneous nature of chlorhexidine-resistant subpopulations suggests that this phenomenon might not be rendered genetically.
  The Journal of hospital infection 03/2012; 81(1):15-9. · 3.01 Impact Factor
• Article: Carriage of methicillin-resistant Staphylococcus aureus on admission to European rehabilitation centres--a prospective study.

  E Bilavsky, Y Lerman, A Rabinovich, J Salomon, C Lawrence, A Rossini, A Salvia, J V Samso, J Fierro, M Hochman, M Kazma, A Klein, M J Schwaber, Y Carmeli
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  ABSTRACT: This study aimed to determine the prevalence of and risk factors for methicillin-resistant Staphylococcus aureus (MRSA) carriage among patients newly admitted to rehabilitation centres. It is a prospective study examining MRSA carriage on admission to seven rehabilitation wards in four countries. Risk factors for MRSA carriage were analysed using univariate and multivariate analyses. A total of 1204 patients were studied. Among them, 105 (8.7%) had a positive admission MRSA screening result. The MRSA carriers were more likely to be male, to have had a recent stay in another long-term-care facility or >2 weeks acute-care hospital stay, history of colonization with MRSA, reduced level of consciousness, peripheral vascular disease and pressure sores. In multivariable logistic regression male gender (odds ratio (OR) 2.2, 95% confidence interval (CI) 1.4-3.6, p 0.001), history of MRSA positivity (OR 6.8, 95% CI 3.8-12.3, p <0.001), peripheral vascular disease (OR 2.5, 95% CI 1.2-5, p 0.013), recent stay in another long-term-care facility (OR 2.1, 95% CI 1.3-3.5, p 0.004), or long (>2 weeks) acute-care hospital stay (OR 1.9, 95% CI 1.2-3, p 0.004), remained significant risk factors for MRSA carriage. MRSA carriage is common on admission to rehabilitation centres but less so, than previously described in long-term-care facilities. Male gender, history of MRSA positivity, previous hospitalization and peripheral vascular disease may predict MRSA carriage, and may serve as indicators for using pre-emptive infection control measures.
  Clinical Microbiology and Infection 03/2012; 18(6):E164-9. · 4.54 Impact Factor
• Article: Molecular epidemiology of methicillin-resistant Staphylococcus aureus in Israel: dissemination of global clones and unique features.

  A Adler, I Chmelnitsky, P Shitrit, H Sprecher, S Navon-Venezia, A Embon, E Khabra, Y Paitan, L Keren, E Halperin, Y Carmeli, M J Schwaber
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  ABSTRACT: From 2006 to 2009, 315 clinical methicillin-resistant Staphylococcus aureus (MRSA) isolates were collected from 5 hospitals across Israel. Most isolates (64%) were related to the global clones spa types t001-SCCmec-I (SCCmec-I stands for staphylococcal cassette chromosome mec type I) (n = 99; 31%), t002-SCCmec-II (n = 82; 26%), and t008-SCCmec-IV (n = 21; 7%), five of which were identified as MRSA strain USA-300. Seventeen strains unique to Israel were identified. SCCmec types IV and V were common among hospital-acquired isolates.
  Journal of clinical microbiology 01/2012; 50(1):134-7. · 4.16 Impact Factor
• Article: Culture-based detection of methicillin-resistant Staphylococcus aureus by a network of European laboratories: an external quality assessment study.

  M Gazin, A Lee, L Derde, M Kazma, C Lammens, M Ieven, M Bonten, Y Carmeli, S Harbarth, C Brun-Buisson, H Goossens, S Malhotra-Kumar
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  ABSTRACT: Twenty-three hospital laboratories from Europe and Israel participated in an external quality assessment (EQA) of the culture-based detection of methicillin-resistant Staphylococcus aureus (MRSA). Participants also reported the MRSA prevalence in clinical cultures and patient screening specimens, as well as the MRSA screening practices employed at their hospitals. An EQA panel of 18 samples consisting of two MRSA harbouring SCCmec IV and I, and one strain each of methicillin-resistant coagulase-negative S. epidermidis, methicillin-sensitive S. aureus and Escherichia coli as pure strains or in mixtures at 10(7)-1 cfu absolute loads was analysed by the 23 participants. Seventeen (74%) participants identified 17 or more samples correctly. Of these, 15 (88%) utilised a chromogenic medium alone (ChromID, bioMérieux; BBL CHROMagar, BD Diagnostics; MRSA Select, Bio-Rad Laboratories) or combined with a conventional medium and up to three confirmatory tests. Proportions of MRSA among S. aureus isolated from clinical cultures varied widely, even among hospitals within countries, ranging from 11-20% to 61-70%. MRSA carriage rates were less variable (0-20%) between countries. Almost all participants (n=22, 96%) screened patients for MRSA carriage during 2009-2010, of which 15 (68%) screened intensive care unit (ICU) patients alone or combined with other targeted high-risk groups, and 10 (45%) combined nasal screening with another body site.
  European Journal of Clinical Microbiology 12/2011; 31(8):1765-70. · 2.86 Impact Factor
• Article: Laboratory evaluation of the ESwab transport system for the recovery of carbapenem-resistant Acinetobacter baumannii.

  J Moran-Gilad, D Schwartz, S Navon-Venezia, Y Carmeli
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  ABSTRACT: Microbiological surveillance for detection of carbapenem-resistant A. baumannii is important, but recovery of A. baumannii is inadequate. We studied A. baumannii recovery by a particular transport system that is possibly superior over standard swabs, using reference and clinical strains. First, the recovery rates relating to the various swabs were compared with regard to various combinations of transport times (0 h, 1 h, 24 h, 48 h), storage times (0 weeks, 1 week, 2 weeks, 4 weeks) and storage temperatures (4°c,-80°c) using live counts. Second, the recovery of different inocula of strains mixed with fecal microbiota was evaluated by plating on selective medium. The new transport system exhibited a decline of <3log10 under almost all conditions studied and performed better than standard swabs under several conditions. If plated on selective media, the new transport system performed well, even after prolonged transport or with a low inoculum, and its processing could be delayed by up to 2 weeks, especially if refrigerated. The new transport system may thus enhance A. baumannii surveillance.
  European Journal of Clinical Microbiology 11/2011; 31(7):1429-33. · 2.86 Impact Factor
• Article: Dissemination of an NDM-2-producing Acinetobacter baumannii clone in an Israeli rehabilitation center.

  P Espinal, G Fugazza, Y López, M Kasma, Y Lerman, S Malhotra-Kumar, H Goossens, Y Carmeli, J Vila
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  ABSTRACT: New Delhi metallo-β-lactamase (NDM-1) was initially identified in various Enterobacteriaceae and recently in Acinetobacter baumannii. This study described the clonal dissemination of an NDM-2-producing A. baumannii isolate in an Israeli rehabilitation ward and the genetic surroundings of the gene. The bla(NDM-2) gene was surrounded by the ble and trpF genes downstream and two copies of the ISAba125 on both sides. These are the first NDM-producing A. baumannii strains in Israel from patients with no previous travel or hospitalization on the Indian subcontinent.
  Antimicrobial Agents and Chemotherapy 08/2011; 55(11):5396-8. · 4.84 Impact Factor