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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 MJ. Detection and characterization of carbapenemase-producing Enterobacteriaceae in wounded Syrian patients admitted to hospitals in northern Israel. Eur J Clin Microbiol Infect Dis 2015; 35:149-54. [PMID: 26581423 DOI: 10.1007/s10096-015-2520-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 10/30/2015] [Indexed: 11/29/2022]
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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Affiliation(s)
- A Lerner
- National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel. .,Reference Laboratory, National Center for Infection Control, 6 Weizmann St., Tel Aviv, 6423906, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - E Solter
- National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - E Rachi
- National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel.,Reference Laboratory, National Center for Infection Control, 6 Weizmann St., Tel Aviv, 6423906, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Adler
- National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel.,Reference Laboratory, National Center for Infection Control, 6 Weizmann St., Tel Aviv, 6423906, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - H Rechnitzer
- Department of Infectious Disease Consultation Service, Ziv Medical Center, Safed, Israel.,Faculty of Medicine in the Galilee, Bar-Ilan University, Ramat Gan, Israel
| | - D Miron
- Department of Infectious Disease Consultation Service, Ziv Medical Center, Safed, Israel.,Faculty of Medicine in the Galilee, Bar-Ilan University, Ramat Gan, Israel
| | - L Krupnick
- Department of Infectious Disease Consultation Service, Ziv Medical Center, Safed, Israel.,Faculty of Medicine in the Galilee, Bar-Ilan University, Ramat Gan, Israel
| | - S Sela
- Infectious Disease Unit, Galilee Medical Center, Nahariya, Israel.,Faculty of Medicine in the Galilee, Bar-Ilan University, Ramat Gan, Israel
| | - E Aga
- Infectious Disease Unit, Galilee Medical Center, Nahariya, Israel.,Faculty of Medicine in the Galilee, Bar-Ilan University, Ramat Gan, Israel
| | - Y Ziv
- Infectious Disease Unit, Galilee Medical Center, Nahariya, Israel.,Faculty of Medicine in the Galilee, Bar-Ilan University, Ramat Gan, Israel
| | - A Peretz
- Infectious Disease Unit, Baruch Padeh Medical Center, Poriya, Israel.,Faculty of Medicine in the Galilee, Bar-Ilan University, Ramat Gan, Israel
| | - K Labay
- Infectious Disease Unit, Baruch Padeh Medical Center, Poriya, Israel.,Faculty of Medicine in the Galilee, Bar-Ilan University, Ramat Gan, Israel
| | - G Rahav
- Infectious Disease Unit, Baruch Padeh Medical Center, Poriya, Israel.,Faculty of Medicine in the Galilee, Bar-Ilan University, Ramat Gan, Israel
| | - Y Geffen
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - K Hussein
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - O Eluk
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Y Carmeli
- National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M J Schwaber
- National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Aga E, Samoli E, Touloumi G, Anderson HR, Cadum E, Forsberg B, Goodman P, Goren A, Kotesovec F, Kriz B, Macarol-Hiti M, Medina S, Paldy A, Schindler C, Sunyer J, Tittanen P, Wojtyniak B, Zmirou D, Schwartz J, Katsouyanni K. Short-term effects of ambient particles on mortality in the elderly: results from 28 cities in the APHEA2 project. Eur Respir J 2003; 40:28s-33s. [PMID: 12762571 DOI: 10.1183/09031936.03.00402803] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Within the framework of the APHEA2 (Air Pollution on Health: a European Approach) project, the effects of ambient particles on mortality among persons > or = 65 yrs were investigated. Daily measurements for particles with a 50% cut-off aerodynamic diameter of 10 microm (PM10) and black smoke (BS), as well as the daily number of deaths among persons > or = 65 yrs of age, from 29 European cities, have been collected. Data on other pollutants and meteorological variables, to adjust for confounding effects and data on city characteristics, to investigate potential effect modification, were also recorded. For individual city analysis, generalised additive models extending Poisson regression, using a locally weighted regression (LOESS) smoother to control for seasonal effects, were applied. To combine individual city results and explore effect modification, second stage regression models were applied. The per cent increase (95% confidence intervals), associated with a 10 microg x m(-3) increase in PM10, in the elderly daily number of deaths was 0.8%, (0.7-0.9%) and the corresponding number for BS was 0.6%, (0.5-0.8%). The effect size was modified by the long-term average levels of nitrogen dioxide (higher levels were associated with larger effects), temperature (larger effects were observed in warmer countries), and by the proportion of the elderly in each city (a larger proportion was associated with higher effects). These results indicate that ambient particles have effects on mortality among the elderly, with relative risks comparable or slightly higher than those observed for total mortality and similar effect modification patterns. The effects among the older persons are of particular importance, since the attributable number of events will be much larger, compared to the number of deaths among the younger population.
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Affiliation(s)
- E Aga
- Dept Hygiene-Epidemiology, University of Athens, Athens, Greece
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