Jacob Strahilevitz

Hebrew University of Jerusalem, Yerushalayim, Jerusalem District, Israel

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Publications (39)193.32 Total impact

  • Maya Korem, Itzhack Polacheck, Jacob Strahilevitz
    Journal of clinical microbiology. 07/2014; 52(7):2744.
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    ABSTRACT: Epidemiological features of infective endocarditis have changed during the last decades because of increases in the prevalence of health care exposure and of Staphylococcus aureus bloodstream infection. Consequently, the role of surgery is evolving. We aim to provide a contemporary profile of epidemiological, microbiological, and clinical features of infective endocarditis in a tertiary medical center, and identify predictors of mortality.
    European Journal of Internal Medicine 06/2014; · 2.05 Impact Factor
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    ABSTRACT: Abstract Infective endocarditis and hepatosplenic abscesses are rare manifestations of cat scratch disease (CSD), especially among immunocompetent adults. An otherwise healthy woman who presented with fever and abdominal pain was diagnosed with multiple abscesses in the spleen and the liver, as well as a mitral valve vegetation. PCR on spleen tissue was positive for Bartonella henselae. Prolonged treatment with doxycycline and gentamicin led to complete recovery. Review of the literature revealed 18 cases of hepatosplenic CSD in immunocompetent adults; the majority presented with fever of unknown origin and abdominal pain. In most cases the causative organism was B. henselae and the pathological findings were necrotizing granulomas, similar to the pathological features in classic CSD. Concomitant endocarditis was diagnosed in one case. Because Bartonella is one of the leading pathogens of culture-negative endocarditis, we raise the question of whether a comprehensive evaluation for endocarditis is needed in cases of systemic CSD.
    Vector borne and zoonotic diseases (Larchmont, N.Y.) 02/2014; · 2.61 Impact Factor
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    ABSTRACT: PCV7 was introduced as universal childhood vaccination in Israel in July 2009 and PCV13 in November 2010. Here we report data on adult invasive pneumococcal disease (IPD), two years post PCV7 implementation and before an expected effect of PCV13. An ongoing nationwide active-surveillance (all 27 laboratories performing blood cultures in Israel), providing all blood & CSF S. pneumoniae isolates from persons >18 y was initiated in July 2009. Capture-recapture method assured reporting of >95% cases. All isolates were serotyped in one central laboratory. IPD outcome and medical history were recorded in 90%. Second year post PCV implementation is compared to the first year. During July 2009 to June 2011, 970 IPD cases were reported (annual incidence [/100,000] of 9.17 and 10.16 in the two consecutive years, respectively). Respective case fatality rates (CFRs) were 20% and 19.1%. Incidence of IPD and CFR increased with age and number of comorbidities. Incidence rate was significantly greater during the second winter, 7.79/100,000 vs. 6.14/100,000 in first winter, p = 0.004, with a non-significant decrease during summer months (3.02 to 2.48/100,000). The proportion of IPD cases due to PCV7-serotypes decreased from 27.5% to 13.1% (first to second year) (p<0.001). Yet, non-PCV13-strains increased from 32.7% to 40.2% (p = 0.017). The increase in non-PCV13-strains was highly significant in immunocompromised patients and to a lesser degree in non-immunocompromised at risk or in older patients (>64 y). Among younger/healthier patients serotype 5 was the major increasing serotype. Penicillin and ceftriaxone resistance decreased significantly in the second year. While overall annual incidence of IPD did not change, the indirect effect of PCV7 vaccination was evident by the significant decrease in PCV7 serotypes across all age groups. Increase in non-VT13 strains was significant in immunocompromised patients. A longer follow-up is required to appreciate the full effect of infant vaccination on annual IPD.
    PLoS ONE 01/2014; 9(2):e88406. · 3.73 Impact Factor
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    ABSTRACT: Repeat episodes of infective endocarditis (IE) can occur in patients who survive an initial episode. We analysed risk factors and 1-year mortality of patients with repeat IE. 1874 patients enrolled in the International Collaboration on Endocarditis-Prospective Cohort Study between January 2000 and December 2006 (ICE-PCS) who had definite native or prosthetic valve IE and 1-year follow-up. Multivariable analysis was used to determine risk factors for repeat IE and 1-year mortality. Of 1874 patients, 1783 (95.2%) had single episode IE and 91 (4.8%) had repeat IE: 74/91(81%) with new infection and 17/91 (19%) with presumed relapse. On bivariate analysis, repeat IE was associated with haemodialysis (p=0.002), HIV (p=0.009), injection drug use (IDU) (p<0.001), Staphylococcus aureus IE (p=0.003), health-care acquisition (p=0.006) and previous IE before ICE enrolment (p=0.001). On adjusted analysis, independent risk factors were haemodialysis (OR 2.5, 95% CI, 1.2-5.3), IDU (OR 2.9, 95% CI 1.6- 5.4), previous IE (OR 2.8, 95% CI, 1.5-5.1) and North American region (OR 1.9, 95% CI 1.1- 3.4). Patients with repeat IE had higher 1-year mortality than those with single episode IE (p=0.003). Repeat IE is associated with IDU, previous IE, and haemodialysis. Clinicians should be aware of these risk factors in order to recognize patients who are at risk for repeat IE. This article is protected by copyright. All rights reserved.
    Clinical Microbiology and Infection 09/2013; · 4.58 Impact Factor
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    ABSTRACT: Objective. To identify predictors of community-onset extended-spectrum β-lactamase (ESBL)-producing Escherichia coli infection. Design. Prospective case-control study. Setting. Acute care hospitals and ambulatory clinics in the Chicago, Illinois, region. Patients. Adults with E. coli clinical isolates cultured in ambulatory settings or within 48 hours of hospital admission. Methods. Cases were patients with ESBL-producing E. coli clinical isolates cultured in ambulatory settings or within 48 hours of admission, and controls were patients with non-ESBL-producing E. coli isolates, matched to cases by specimen, location, and date. Clinical variables were ascertained through interviews and medical record review. Molecular methods were used to identify ESBL types, sequence type ST131, and aac(6')-Ib-cr. Results. We enrolled 94 cases and 158 controls. Multivariate risk factors for ESBL-producing E. coli infection included travel to India in the past year (odds ratio [OR], 14.40 [95% confidence interval (CI), 2.92-70.95]), ciprofloxacin use (OR, 3.92 [95% CI, 1.90-8.1]), and age (OR, 1.04 [95% CI, 1.02-1.06]). Case isolates exhibited high prevalence of CTX-M-15 (78%), ST131 (50%), and aac(6')-Ib-cr (66% of isolates with CTX-M-15). Conclusions. Providers should be aware of the increased risk of ESBL-producing E. coli infection among returned travelers, especially those from India.
    Infection Control and Hospital Epidemiology 09/2013; 34(9):947-53. · 4.02 Impact Factor
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    ABSTRACT: Exserohilum rostratum is the most common pathogen in the current US outbreak of fungal central nervous system infection, septic arthritis and localized spinal or paraspinal infections (1).…
    Journal of clinical microbiology 05/2013; · 4.16 Impact Factor
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    ABSTRACT: PURPOSE: Colistin is increasingly used as the last-resort treatment option against infections caused by multidrug-resistant (MDR) Gram-negative pathogens, but its nephrotoxicity is of concern, especially in severely ill patients. The aim of this study was to analyze the toxicity of colistin therapy in adults and children with hematological malignancies (HM) and hematopoietic stem cell transplantation (HSCT) recipients. METHODS: Data on HSCT recipients and HM patients, treated with intravenous colistin (2.5-5 mg/kg/day in children and 3-6 million international units (IU) in adults, adjusted to renal function) during the period 2008-2011 in our center, were retrospectively collected and analyzed. Nephrotoxicity was defined according to the RIFLE criteria (Risk, Injury, Failure, Loss, and End-stage kidney disease). RESULTS: Twenty-nine children and adults received 38 courses of intravenous colistin (2.5-5 mg/kg/day in children and 3-6 × 10(6) IU in adults, adjusted to renal function) [allogeneic HSCT (22 courses) and HM (16 courses)] for 3-28 days (median 10 days) for empirical therapy for nosocomial clinical sepsis (28) or local infection (6), and bacteremia with MDR Gram-negative rods (4). Nephrotoxicity was observed at the end of 4 (10.5 %) courses. In 32 (84 %) courses, nephrotoxic medications were concomitantly administered. Two patients had convulsions, probably unrelated to colistin. Seven patients (18 %) died while on colistin therapy. No death was attributed to an adverse effect of colistin. CONCLUSIONS: Treatment with intravenous colistin, with dosage adjusted to renal function, was relatively safe for HM/HSCT patients, even with concomitantly administered nephrotoxic medications. Concern about nephrotoxicity should not justify a delay in initiating empirical colistin treatment in situations where infection with MDR Gram-negative rods is likely.
    Infection 05/2013; · 2.44 Impact Factor
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    ABSTRACT: Pneumococcal infections in adults vary in severity and incidence is affected by childhood vaccination policy. Here, we try to define the host determinants and the interaction with specific serotypes that result in invasive pneumococcal disease (IPD) before an expected effect of pneumococcal conjugate vaccines. A nationwide active surveillance was initiated on July 2009, at the time of national implementation of PCV7 in Israel. The surveillance included all 27 laboratories and medical centers performing blood cultures in Israel, providing all blood and CSF pneumococcal isolates from persons =18y. Capture-recapture method assured that >95% of all cases were reported. IPD outcome and medical history were recorded and isolates were serotyped. Four hundred and sixty IPD cases were reported (annual incidence [/100,000] of 9.25). Incidence increased with age, from 2.6 among 18-34y to 66.8 among =85y. The most common diagnosis was pneumonia (72.4%), followed by bacteremia with no apparent focus (20.2%). Case fatality rate increased with age and number of comorbidities (34.5% for =75y or those with =3 comorbidities vs. 9.2-11.2% among <65y or those with no comorbidities; p=0.015). Variables independently associated with mortality were: age =75, chronic renal failure, malignancy, neurosurgery, alcohol abuse, multi-lobar pneumonia and sepsis with no apparent focus. The predominant serotypes in patients 18-49y were 1, 5, 8, 7F and 9V (constituting 56.3% in this age-group vs. 11.9% in =75y; p<0.01). The predominant serotypes among patients =75y were 3, 19A, 23F and 14 (40.3% of this age-group vs. 12.9% of 18-49y; p<0.01). Overall, PCV7 and PCV13 covered 25.6% and 63.7% of isolates, respectively, and 30.9% and 67.9% of isolates in mortality cases respectively. This nationwide active surveillance provides the baseline incidence, mortality rates and risk group distributions of IPD in adults before expected PCV effect.
    Vaccine 03/2013; · 3.77 Impact Factor
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    ABSTRACT: A bla(KPC-9) carbapenemase variant was discovered in isolates of Klebsiella pneumoniae and Escherichia coli from a single patient. It differed from bla(KPC-3) by one amino acid substitution (Val239Ala). The K. pneumoniae isolate was typed as ST258, as was the epidemic Israeli KPC-3 clone. bla(KPC-9) was found on a plasmid indistinguishable from pKpQIL that carries bla(KPC-3) in the epidemic clone. Compared to KPC-3, KPC-9 conferred less resistance to carbapenems and higher resistance to ceftazidime.
    Antimicrobial Agents and Chemotherapy 09/2012; 56(11):6057-9. · 4.57 Impact Factor
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    ABSTRACT: A refractory epidemic of carbapenem-resistant Klebsiella pneumoniae (CRKP) emerged in the adult population at our hospital in 2005, as in most Israeli hospitals. Contemporaneously, a different clone of CRKP caused an easily contained outbreak in a paediatric long-term care facility (LTCF) in Jerusalem. While previously identified host-related risk factors for colonization by these organisms undoubtedly contributed to these outbreaks, it is very likely that bacterial factors might be crucial in explaining the striking differences in transmissibility between the implicated strains. We therefore sought bacterial factors associated with these different epidemiological behaviours. Seven CRKP isolated at our hospital and the LTCF during 2008-09 were examined by antimicrobial susceptibility testing and PFGE, and further analyses of these two clones was done using multilocus sequence typing and competition experiments. Plasmids were analysed by conjugation, restriction mapping, PCR and sequencing. Both clones were multidrug resistant and harboured identical plasmids carrying the bla(KPC-3) gene. The hyper-transmissible epidemic clone carried additional antibiotic resistance genes and hosted an additional plasmid. The clone from the LTCF did not demonstrate hyper-transmissible properties despite its presence in an institution of a type commonly plagued by the epidemic clone. Competition assays showed the more easily contained strain to be fitter. These findings suggest that neither the presence of the plasmid carrying the bla(KPC-3) gene nor relative survival fitness account for the hyper-transmissibility of the epidemic strain. The role of patient age in susceptibility to colonization by the epidemic strain should be investigated.
    Journal of Antimicrobial Chemotherapy 04/2012; 67(7):1651-4. · 5.34 Impact Factor
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    ABSTRACT: We characterized distinctive features of a hypertransmissible carbapenem-resistant Klebsiella pneumoniae (CRKP) clone that emerged at Hadassah Hospital, Ein-Kerem, Jerusalem, Israel, in 2006. Eleven CRKP isolated at Hadassah Hospital during 2005-09 were examined by antimicrobial susceptibility testing, PFGE and multilocus sequence typing (MLST). Plasmids were analysed by conjugation, restriction mapping, PCR and sequencing. Divergence from the national epidemic sequence type (ST) ST258 to ST512 was observed early on. Carbapenem resistance was conferred by bla(KPC-3) carried on a plasmid apparently closely related to pKpQIL, also from Israel. This clone also carried a 15 kb plasmid, designated pAAC154, that carries a Tn1331 derivative containing the aac(6')-Ib gene. pAAC154 does not carry a bla(KPC) gene, but is similar to pS15, a plasmid from New York that carries bla(KPC-2). A single CRKP clone ST512 has spread efficiently in our region. In this clone, aac(6')-Ib, common in CRKP strains, is carried on a different plasmid from bla(KPC-3).
    Journal of Antimicrobial Chemotherapy 01/2012; 67(4):898-901. · 5.34 Impact Factor
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    ABSTRACT: Cytotoxic chemotherapy induces changes in the oral microflora that may cause oral and systemic infections in myelosuppressed cancer patients. These complications prompted us to assess the antimicrobial activity of a topical Iseganan HCl mouthwash vs. placebo on the aerobic and facultatively anaerobic oral flora in these patients. Two hundred and twenty-five chemotherapy patients were recruited into a randomized, double-blind, placebo-controlled trial, conducted at multiple centers. The study compared the antimicrobial efficacy of Iseganan HCl vs. placebo (95% of the Iseganan and 97% of the control group received myeloablative chemotherapy). Iseganan HCl 9 mg/3 ml was administered as a swish and swallow solution, six times daily for 21-28 days. Microbial cultures were made before and after the daily Iseganan mouth rinse on the first and final days of chemotherapy. The reduction in total microbial load after the first day of treatment was statistically significant (1.59 vs. 0.18 log10 CFU for the Iseganan HCl and placebo groups, respectively, P < 0.0001). Iseganan HCl rinse had a cumulative effect demonstrated by the significant difference between the two groups on the last day of the study (i.e. completion of Iseganan daily treatment) (P < 0.05). The reduction was mainly due to decreased densities of viridans streptococci, non-hemolytic streptococci, and yeasts. The minimal inhibitory concentration (MIC) of Iseganan HCl remained the same throughout the course of treatment. Topical Iseganan HCl significantly reduces the total oral aerobic bacterial, streptococcal, and yeast load. Its potential as an oral antimicrobial agent in preventing these types of infections is clear.
    Journal of Oral Pathology and Medicine 11/2011; 41(3):229-34. · 2.06 Impact Factor
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    Carlos Hidalgo-Grass, Jacob Strahilevitz
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    ABSTRACT: We have developed a simple PCR-based high-resolution melt curve analysis for identification of the quinolone resistance gene aac(6')-Ib-cr through regions encompassing the two defining single nucleotide mutations. Dissociation curves showed 100% concordance with DNA sequencing, including the identification of a strain where aac(6')-Ib and aac(6')-Ib-cr coexist.
    Antimicrobial Agents and Chemotherapy 05/2010; 54(8):3509-11. · 4.57 Impact Factor
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    ABSTRACT: Although plasmid-mediated quinolone resistance (PMQR) was thought not to exist before its discovery in 1998, the past decade has seen an explosion of research characterizing this phenomenon. The best-described form of PMQR is determined by the qnr group of genes. These genes, likely originating in aquatic organisms, code for pentapeptide repeat proteins. These proteins reduce susceptibility to quinolones by protecting the complex of DNA and DNA gyrase or topoisomerase IV enzymes from the inhibitory effect of quinolones. Two additional PMQR mechanisms were recently described. aac(6')-Ib-cr encodes a variant aminoglycoside acetyltransferase with two amino acid alterations allowing it to inactivate ciprofloxacin through the acetylation of its piperazinyl substituent. oqxAB and qepA encode efflux pumps that extrude quinolones. All of these genes determine relatively small increases in the MICs of quinolones, but these changes are sufficient to facilitate the selection of mutants with higher levels of resistance. The contribution of these genes to the emergence of quinolone resistance is being actively investigated. Several factors suggest their importance in this process, including their increasing ubiquity, their association with other resistance elements, and their emergence simultaneous with the expansion of clinical quinolone resistance. Of concern, these genes are not yet being taken into account in resistance screening by clinical microbiology laboratories.
    Clinical microbiology reviews 10/2009; 22(4):664-89. · 14.69 Impact Factor
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    ABSTRACT: We aimed to evaluate the occurrence and characteristics of plasmid-mediated quinolone resistance (PMQR) genes in KPC-producing (KPC-P) Klebsiella pneumoniae (Kpn) isolates in Tel Aviv Medical Center, Israel. Forty-seven KPC-P Kpn isolates were studied. Antibiotic susceptibilities were determined by Vitek 2, Etest or agar dilution. Beta-lactamases and PMQR determinants were detected by PCR. For plasmid characterization, transformation, transconjugation, restriction mapping and Southern blot analysis were performed. Six out of 47 (13%) KPC-P isolates carried aac(6')-Ib-cr. Acquisition of aac(6')-Ib-cr-encoding plasmids increased the MIC of ciprofloxacin by 2-fold. In five of six KPC-P isolates, aac(6')-Ib-cr and bla(KPC-2) were encoded on the same plasmid. The most prevalent PMQR gene in the studied KPC-P K. pneumoniae isolates is aac(6')-Ib-cr. The co-existence of PMQR genes with KPC on the same plasmid poses a serious epidemiological, clinical and public-health threat.
    Journal of Antimicrobial Chemotherapy 09/2009; 64(4):718-22. · 5.34 Impact Factor
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    ABSTRACT: Enterobacteriaceae are rarely the etiologic agents of endocarditis, with Klebsiella species being especially rare. From the end of 2005, isolates of carbapenem-resistant Klebsiella pneumoniae began to appear in various hospitals across Israel, sensitive only to colistin and gentamicin. We present a case of hospital-acquired endocarditis caused by carbapenem-resistant K. pneumoniae in a young adult. An 18-year-old man with 40% full thickness burns developed acute bacterial endocarditis complicated by embolic myocardial infarction. Carbapenem-resistant K. pneumoniae carrying the blaKPC3 gene was isolated from multiple blood cultures. He recovered fully after antibiotic treatment with colistin and gentamicin. To our knowledge, this is the first reported case of acute bacterial endocarditis caused by carbapenem-resistant K. pneumoniae. The combination of intravenous colistin and gentamicin was effective and resulted in the cure of this patient's endocarditis without the need for surgical intervention.
    International journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases 04/2009; 13(5):e295-8. · 2.17 Impact Factor
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    ABSTRACT: Clinical isolates of Escherichia coli collected from 1991 through 2005 at a tertiary-care center were studied for qnr and aac(6')-Ib-cr genes. Isolates bearing aac(6')-Ib-cr emerged in 1998, coinciding with an increase in ciprofloxacin resistance. The presence of aac(6')-Ib-cr was multiclonal and was associated with the presence of extended-spectrum beta-lactamases.
    Antimicrobial Agents and Chemotherapy 01/2009; 53(3):1268-70. · 4.57 Impact Factor
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    Emerging Infectious Diseases 11/2008; 14(10):1667-9. · 6.79 Impact Factor
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    ABSTRACT: Fourteen out of 16 carbapenem-resistant quinolone-susceptible Enterobacter cloacae isolates were found to carry qnrB2 and bla(KPC-2) genes encoded on the same plasmid. One isolate also carried the aac(6')-Ib-cr gene. Coexistence of quinolone resistance determinants and bla(KPC-2) on the same plasmid in quinolone-susceptible E. cloacae isolates may have important clinical implications.
    Antimicrobial Agents and Chemotherapy 08/2008; 52(8):2962-5. · 4.57 Impact Factor

Publication Stats

1k Citations
193.32 Total Impact Points


  • 2009–2014
    • Hebrew University of Jerusalem
      • Department of Oral Medicine
      Yerushalayim, Jerusalem District, Israel
    • NorthShore University HealthSystem
      • Department of Medicine
      Chicago, Illinois, United States
  • 2013
    • Mayo Clinic - Rochester
      Rochester, Minnesota, United States
  • 2007–2010
    • Hadassah Medical Center
      • Division of Microbiology and Infectious Diseases
      Yerushalayim, Jerusalem District, Israel
  • 2006
    • Harvard Medical School
      Boston, Massachusetts, United States
    • Kenya Centers for Disease Control and Prevention
      Winam, Kisumu, Kenya
  • 2005–2006
    • Massachusetts General Hospital
      • Division of Infectious Diseases
      Boston, MA, United States
    • Tel Aviv University
      Tell Afif, Tel Aviv, Israel
  • 2002–2003
    • Sheba Medical Center
      Gan, Tel Aviv, Israel