국내 종합병원에서 발생한 KPC-2 생성 Klebsiella pneumoniae 집단 발생에 대한 역학 분석 연구
Epidemiological Study of an Outbreak of KPC-2-producing Klebsiella pneumoniae in a Tertiary Hospital in Korea
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배경: Carbapenemase-producing Enterobacteriaceae (CPE)는 전세계적으로 빠르게 증가하고 있고, 특히 KPC-2 생성 Klebsiella pneumoniae는 높은 비율을 차지하고 있어 공중보건의 큰 위협으로 자리잡고 있다. 본 연구는 국내 한 종합병원에서 발생한 KPC-2 생성 K. pneumoniae 균주 간의 분자 역학적 연관성을 확인하여 임상적 의의를 확인하고자 한다. 방법: 2018년 4월부터 12월까지 임상에서 분리된 carbapenem계 항생제에 비감수성인 K. pneumoniae를 수집하여 본 연구에 사용하였다. 수집된 균주 중 pulsotype별 대표 균주를 무작위로 선정하였으며, 선정된 균주를 대상으로 디스크 확산법을 통해 항생제 감수성 여부를 확인하였으며, 중합효소연쇄반응 및 시퀀싱으로 KPC형 생성 여부를 확인하였다. 또한, pulsed-field gel electrophoresis (PFGE)와 multilocus sequencing typing를 통해 분자역학적 연관성을 확인하였다. 결과: 총 100주의 KPC-2 생성 K. pneumoniae가 분리되었고, PFGE 결과 대표적으로 2가지의pulsotype으로 구분되었다(pulsotype A, 31.0%, n = 31; pulsotype B, 63.0%, n = 63). Pulsotype A는ST395에 해당하였고 pulsotype B는 ST307에 해당하였다. 결론: KPC-2 생성 K. pneumonia 집단발생 예방을 위해 임상정보 및 세균학적 요인을 조사하였으며 감염 시 높은 사망률을 갖고 있는 다제내성균 전파의 예방을 위한 적절한 감염관리 활동과 구축이 필요함을 알 수 있었다.
Abstract
Background: The prevalence of carbapenemase-producing Enterobacteriaceae (CPE), especially the KPC-2-producing Klebisella pneumoniae, is rapidly increasing and becoming a menace to global public health. This study aims to present the molecular epidemiology of the KPC-2-producing K. pneumoniae isolates emerged in a tertiary hospital in South Korea and describe its clinical significance. Methods: This study included carbapenem-resistant K. pneumoniae isolates collected from a tertiary hospital from April to December in 2018. Antimicrobial susceptibility of K. pneumoniae isolates was tested using disk diffusion method. PCR and DNA sequence analyses were performed to identify the resistance genotype. In addition, the molecular epidemiology was investigated using pulsed-field gel electrophoresis (PFGE) and multilocus sequencing typing (MLST). Results: Total 100 KPC-2-producing K. pneumoniae isolates were collected, which were mainly classified into two pulsotypes according to the XbaI restriction digestion pattern by PFGE analysis (pulsotype A, n = 31; pulsotype B, n = 63). The isolates exhibiting pulsotype A belonged to ST395 and the remaining isolates exhibiting pulsotype B were attributed to ST307 by MLST analysis. Conclusion: This study investigated clinical information and molecular bacterial profiles for KPC-2-producing K. pneumoniae isolates. These findings indicate that the proper infection control activities are needed to prevent the spread of multidrug-resistant organisms such as CPE, which could cause high mortality in clinical field.
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