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뮤피로신 내성 황색포도알균의 빈도 및 임상적 특성

Prevalence and Clinical Characteristics of Mupirocin-Resistant Staphylococcus aureus

김상경|전창호|서헌석|이아진
대한임상미생물학회 (Korean Society of Clinical Microbiology)|2011.03|Annals of Clinical Microbiology|제14권 제1호|pp. 18-23

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키워드

Staphylococcus aureusDrug resistanceMupirocin

초록

배경: 메티실린 내성 황색포도알균(MRSA)의 비강 정착은 원내 전파 및 감염의 위험인자로 알려져 있다. MRSA의 비강정착을 제거하기 위하여 국소 항생제인 뮤피로신이 사용된다. 하지만 뮤피로신의 사용이 증가됨에 따라 뮤피로신 내성이 전 세계적인 문제로 대두되고 있다. 본 연구는 임상검체에서 분리된 황색포도알균에서 뮤피로신 내성의 빈도와 연관된 임상적 지표를 분석하고자 하였고 항생제 감수성 양상을 조사하였다. 방법: 4개월 동안 의뢰된 임상 검체 중 황색포도알균이 분리된 175개의 균주를 대상으로 Vitek2 자동화 장비를 이용하여 뮤피로신 내성 및 그 외의 항생제 감수성 검사를 시행하였다. 뮤피로신 내성을 보이는 균주 모두와 뮤피로신 감수성을 보이는 균주를 선택하여 mupA 유전자를 분석하였다. 균주의 임상 지표 또한 조사하였다. 결과: 175개의 황색포도알균 중 9.1% (16/175)가 뮤피로신에 내성을 보였는데 1.7% (3/175)가 고농도 내성이었고, 7.4% (13/175)가 저농도 내성이었다. 뮤피로신 내성을 가지는 황색포도알균의 경우 입원기간이 길었다(P=0.026). 뮤피로신에 저농도 내성을 보이는 13개의 균주 중 11균주가 동일한 항생제 감수성 양상을 보였다. mupA 유전자는 뮤피로신에 고농도 내성을 보이는 균주에서만 검출되었다. 결론: 황색포도알균에서 뮤피로신 내성률이 높았다. 뮤피로신 내성 황색포도알균의 전파는 원내감염에 의한 것으로 생각된다.

Abstract

Background: Nasal colonization with methicillin-resistant Staphylococcus aureus (MRSA) is a known risk factor for nosocomialtransmission and infection. In an effort to mitigate this problem, topical mupirocin has been widely used for clearing nasal carriage of MRSA. However, mupirocin resistance has become a worldwide concern due to increased use of the antibiotic. The aims of this study were to evaluate the clinical characteristics and prevalence of mupirocin resistance among clinical isolates of staphylococci and to investigate antimicrobial susceptibility. Methods: A total of 175 S. aureus specimens recovered over a 4-month period from various body sites were tested for resistance to mupirocin and other antibiotics using the Vitek2 automated system. The presence of the mupA gene was assessed in isolates exhibiting resistance to mupirocin and in other selected organisms. The clinical characteristics of the isolates were also reviewed. Results: Of the 175 S. aureus isolates, 9.1% (16/175) were resistant to mupirocin, with 1.7% (3/175) having high-level resistance (HR) and 7.4% (13/175) having low-level resistance (LR). Patients with HR-mupirocinresistant S. aureus had a longer duration of hospitalization (P=0.026). Of the 13 LR-mupirocin-resistant S. aureus strains, 11 had identical antibiogram patterns. The mupA gene was detected only among HR isolates. Conclusion: The rate of mupirocin resistance in the S. aureus isolates was high. The spread of mupirocinresistant S. aureus may be due to nosocomial infection.

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