Introduction of OXA-48-producing Enterobacteriaceae to Israeli hospitals by medical tourism.

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 bla(OXA-48)-carrying plasmids were investigated using S1 endonuclease and restriction fragment length polymorphism (RFLP). Conjugation efficiency of the bla(OXA-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 bla(OXA-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 bla(OXA-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 bla(OXA-48)-carrying plasmid demonstrated remarkable conjugation efficiency, which is probably important in the success of its dissemination.

Effects of Oestradiol and the Oestrogen Antagonist lei 182,780 on the Delayed Type Hypersensitivity (DTH) Index and on Serum Levels of lgM and lgG in Ovariectomised Balb/C and MRL/Mp-Lpr/Lpr Mice, a Model of Systemic Lupus Erythematosus (SLE).

The effects of oestradiol and the oestrogen receptor antagonist ICI 182,780 were investigated on the DTH index, serum IgG and IgM levels and spleen weight in female BALB/c and MRLIMP-Ipr/lpr mice. At six weeks, the mice were ovariectomisecl, and one week later, over a four-week period, given biweekly s.c. doses of (i) 5µJ l of oli ve oil, or (i i) 5 µ1 of oil containing 3.2 µg of 17ß-oestradiol (E2), or (iii) 5 µl of oil containing (3.2 µl of E2 + ICI 182,780 , at a dose of 30 mg/kg), or (iv) the same dose of ICI 182,780 alone. E2 significantly raised the DTH index in BALB/c mice; this effect was prevented if ICI 182,780 was included in the injectio n . The DTH index in MRL mice was unaffected by any of the treatments. All steroid u·eatments raised serum IgG levels in BALB/c mice, but those in sera of MRL were un affected and were significantly higher than those measured in BALB/c mice . ICI 182,780 depressed TgM in BALB/c mice, while all steroidtreatments increased JgM in MRL mice. ICI 182,780 de pressed spleen weights in both strains. Oes u·ogen may influence Bcell functiontlu·ough ICI 182,780-se nsitive receptors, and ICI 182,780 may have agonist actions on the immune system. (200 words).