Introduction of OXA-48-producing enterobacteriaceae to israeli hospitals by medical tourism

Amos Adler, Maya Shklyar, Mitchell J. Schwaber, Shiri Navon-venezia, Yacoub Dhaher, Rotem Edgar, Ester Solter, Shmuel Benenson, Samira Masarwa, Yehuda Carmeli

Research output: Contribution to journalArticlepeer-review

60 Scopus citations


Objectives: The carbapenemase OXA-48 has been reported from different Mediterranean countries. It is mostly encoded on a single plasmid in various Enterobacteriaceae species. We characterized the epidemiological and molecular features of OXA-48-producing Enterobacteriaceae (OPE) in Israel. Methods: Epidemiological investigation was conducted by the National Center for Infection Control. Genotyping was performed using multilocus sequence typing. The blaOXA-48-carrying plasmids were investigated using S1 endonuclease and restriction fragment length polymorphism (RFLP). Conjugation efficiency of the blaOXA-48-carrying plasmids was studied in a filter mating experiment. Results: Since 2007, four OPE-infected patients were identified, all non-Israeli (two Palestinian, one Jordanian and one Georgian). Three had prior hospitalization; two in Jordan and one in Georgia. The blaOXA-48 gene was detected in three Escherichia coli strains belonging to different clonal complexes, one Klebsiella oxytoca and one Klebsiella pneumoniae sequence type 101, as previously reported from Tunisia and Spain. In all isolates, the blaOXA-48 gene was located inside Tn1999.2 and was carried on a 60 kb plasmid with an identical RFLP pattern. The plasmid was able to conjugate from Klebsiella spp. to E. coli, and had a conjugation efficiency up to ~10000 times higher than that of pKpQIL. Conclusions: OPE, introduced mainly by medical tourism, are an emerging threat to patients from affected Mediterranean countries. The blaOXA-48-carrying plasmid demonstrated remarkable conjugation efficiency, which is probably important in the success of its dissemination.

Original languageEnglish
Article numberdkr382
Pages (from-to)2763-2766
Number of pages4
JournalJournal of Antimicrobial Chemotherapy
Issue number12
StatePublished - Dec 2011
Externally publishedYes


  • Carbapenemases
  • Conjugation
  • Plasmids


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