Shiga toxin-producing Escherichia coli (STEC) is a significant cause of gastrointestinal infection and the haemolytic-uremic syndrome (HUS). STEC outbreaks are commonly associated with food but animal contact is increasingly being implicated in its transmission. We report an outbreak of STEC affecting young infants at a nursery in a rural community (three HUS cases, one definite case, one probable case, three possible cases and five carriers, based on the combination of clinical, epidemiological and laboratory data) identified using culture-based and molecular techniques. The investigation identified repeated animal contact (animal farming and petting) as a likely source of STEC introduction followed by horizontal transmission. Whole genome sequencing (WGS) was used for real-time investigation of the incident and revealed a unique strain of STEC O26:H11 carrying stx2a and intimin. Following a public health intervention, no additional cases have occurred. This is the first STEC outbreak reported from Israel. WGS proved as a useful tool for rapid laboratory characterization and typing of the outbreak strain and informed the public health response at an early stage of this unusual outbreak.

The pediatric CA-MRSA clone, previously described only in sporadic cases in Israel, is emerging among healthy, young Bedouin children, typically causing SSTI. Isolates are susceptible to a variety of non-beta lactam antibiotics.

BackgroundPediatric CA-MRSA infections are emerging worldwide. High CA-MRSA carriage rates were previously described in healthy Bedouin children (Adler et al, J Clin Microbiol 2009). We assessed demographic, clinical and molecular characteristics of MRSA infections in children in southern Israel.MethodsSoroka University Medical Center microbiology laboratory serves the entire population of southern Israel, divided into two ethnic groups, Bedouin and Jews. All in-hospital MRSA isolates from children 0–18 years, obtained in 2016 were included.Clinical data were recorded from the hospital’s computerized records. Health-care associated (HA) and community-associated infections were defined according to the US Center for Disease Control and Prevention. All isolates were evaluated for staphylococcal cassette chromosome (SCCmec), Panton–Valentine leucocidin (PVL), Staphylococcus aureus protein A (spa) type as well as by pulsed-field-gel-electrophoresis (PFGE) and antimicrobial susceptibility testing.ResultsOverall 95 (18%) of S. aureus isolates were MRSA (Table 1). Twenty-five different MRSA strains were identified. 28 isolates (29.5% of all MRSA) belonged to a pediatric clone, rarely observed in Israel (SCC IV, PVL positive, spa type 002; all demonstrate identical PFGE fingerprints). 82% of infections caused by this clone were community-acquired and were mainly observed in young Bedouin children, causing skin and soft-tissue infections (SSTI). Comparisons between the new clone and other CA-MRSA and HA-MRSA strains are shown in Table 1. All isolates of the pediatric clone were susceptible to TMP/SMX, ciprofloxacin, gentamicin, tetracycline, rifampicin and vancomycin; 17.8% were nonsusceptible to erythromycin and clindamycin (Table 2).ConclusionThe pediatric CA-MRSA clone, previously described only in sporadic cases in Israel, is emerging among previously healthy, young Bedouin children, typically causing SSTI. Isolates are susceptible to a variety of non-β lactam antibiotics.Disclosures All authors: No reported disclosures.

Background. The clonal repertoire of community-associated Methicillin-resistant Staphylococcus aureus (CA-MRSA) strains appear to differ between hospitals and geographic locations. We aimed to study the molecular epidemiology of MRSA infections in our regional hospital in Israel. Methods. A retrospective analysis of MRSA isolates from hospitalized patients, which underwent spa typing between 2012 and 2019. Mainly, MRSA-bloodstream isolates were typed. Isolates were grouped into healthcare-associated (HcA) or community-associated (CA). HcA were further divided into hospital-related or long-term care facility- (LTCF-) related. Several representatives underwent SCCmec typing. Results. We analyzed 166 clinical MRSA isolates: 115 (70%) bloodstream, 42 (25%) wounds/abscesses, and 9 (5%) screening isolates. 145 (87%) were HcA, and 21 (13%) were CA. Common (72%) spa types were t002, t032, t008, t001, and t065. Eighty (55%) isolates were attributed to LTCFs and 65 isolates to our hospital, both showing similar spa types distribution. The most prevalent spa type among patients with HcA infection was t002 (50 isolates, 32%), followed by t032, t065, t578, t008, and t001. Most (88/115, 77%) bloodstream infections (BSIs) were HcA, typically occurring in the same facility in which the infection was acquired. In 27 cases (23%), the BSI developed in the community setting, and in half of these cases, a previous healthcare system exposure was evident. Conclusions. The MRSA clonal population in this longitudinal study was stable and consisted mainly of molecular lineages widespread in Europe. SCCmec-IV strains play a major role in causing MRSA infections in the healthcare settings, especially in LTCFs. Community-acquired MRSA BSIs without any previous healthcare exposure are still relatively rare.

Background MRSA is a major global healthcare problem. In 2011, a new mec variant designated mecC was described, presenting partial identity at the DNA level, thus undetectable by routine mecA PCR. Objectives Until now, no reliable information regarding mecC MRSA prevalence was available in Israel. In this study, to the best of our knowledge, we describe the first case of mecC MRSA in Israel, with focus on genomic analysis and global context. Methods The mecC MRSA isolate was analysed by WGS with focus on phylogeny, global contextualization, virulence and resistance genes. The strain was characterized by antibiotic susceptibility testing, spa typing and presence of mecA/C and pvl genes. Results An MRSA strain (SA10610), isolated from a urine sample of an 83-year old patient, was found negative for the mecA and pvl genes. The MLST and spa type were ST130 and t1736, respectively. SA10610 presented resistance to oxacillin, penicillin and cefoxitin, and susceptibility to all non-β-lactam agents tested. Phylogenetic comparison with a global dataset of 586 mecC MRSA genomes revealed substantial genomic divergence. The nearest genomic relatives were human and animal isolates from Denmark. A screen of 12 761 S. aureus isolates collected during 2011–18 in Israel indicated this is the only mecC-positive strain. Conclusions A high degree of genetic variability was found between the SA10610 strain and previously sequenced mecC MRSA isolated worldwide. The genomic and phylogenetic analysis suggest that mecC MRSA isolates have evolved independently rather than from a common ancestor.