363Persistence of the Klebsiella pneumoniae Sequence Type 258 as the Predominant Clone of Carbapenemase-Producing Enterobacteriaceae in Post-Acute Care Facilities in Israel, 2008-2013

Background. We aimed to study the molecular characteristics and clonal structure of carbapenemase-producing Enterobacteriaceae(CPE) in post-acute care facilities (PACF’s) in Israel and to analyze the temporal changes that have occurred between 2008 and 2013. Methods. The prevalence of CPE carriage in PACF’s in Israel was determined in two point prevalence national surveys done in 2008 and 2013. The source of CPE acquisition in the 2013 survey was determined based on the National Center of Infection Control database. Surveillance cultures were collected by rectal swabs and were inoculated onto selective media. Isolates were identified by the VITEK-2 system and were tested for the production of carbapenemase by the blaKPC, blaNDM and blaOXA48 –PCR’s and by the Carba NP test. Molecular typing was done by PCR for the pilV-l gene, designed for a specific allele of the sequence-type (ST)-258 KPC-producing Klebsiella pneumoniae(KPC-KP) clone, by BOX-PCR and by MLST. Results. The prevalence of CPE in the first survey was 184/1,144 (16.1%), all of which were KPC-KP. The prevalence of CPE in the second survey was 127/1,287 (9.9%), of which 113 (89%) were KPC-KP, 9 (7%) were other KPC-producing species and 5 (4%) were NDMor OXA-48 producing CPE’s (n = 1 and 4, respectively). The proportion of the ST-258 clone within the KPC-KP population increased from 120/184 (65%) to 91/113 (80%) in the 2008 and 2013 surveys, respectively. Meanwhile, the proportion of the ST-340 clone within the KPC-KP population decreased from 41/184 (22.5%) to 9/113 (7.9%) in the 2008 and 2013 surveys, respectively. In 83 of the 122 KPC-CPE carriers (68%) identified in the 2013 survey, the source of acquisition was determined to be the PACF itself. All 4 OXA-48 CPE’s were acquired either directly or indirectly from patients arriving from the Palestinian Authority or Syria. Conclusion. Despite the decreased prevalence and the emergence of new types of CPE’s in Israel, the ST-258 KPC-KP clone remains the leading culprit of the CPE epidemic in PACF’s. Disclosures. All authors: No reported disclosures.