Pulsed-field gel electrophoresis를 이용한 중환자실 Serratia marcescens 집단요로감염의 역학적 조사
Epidemiologic Investigation of an Outbreak of Serratia marcescens Urinary Tract Infection in an Intensive Care Unit Using Pulsed-Field Gel Electrophoresis
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배경：Serratia marcescens는 원내감염의 중요한 원인균이다. 본 연구에서는 외과계중환자실에서 집단발생한 S. marcescens 감염의 감염원을 추적 조사하고 역학조사로서의 PFGE 유용성을 알아보고자 하였다. 방법：2003년 5월부터 8월까지 경상대학교병원 외과계중환자실 환자로부터 분리된 S. marcescens 28균주와 입원병동에서 분리된 11균주를 대상으로 하였다. 중환자실의 검체는 도뇨기구를 통한 소변검체가 26검체로 가장 많았다. 감염원을 추적하기 위해 중환자실 종사자의 손, 사용 중이던 소변통, 소독된 소변통 등 총 56개의 환경검체에 대한 배양검사를 실시하였으며 항균제 감수성 검사와 PFGE를 이용하여 동일 클론에 의한 감염인지를 알아보았다. 결과：PFGE 결과 중환자실 검체에서 분리된 28균주 중 20개가 동일한 유형을 보였고 2균주는 그 아형으로 중환자실에서 요로감염을 일으킨 S. marcescens가 단일 클론임을 확인 할 수 있었다. 항균제 감수성 검사에서는 imipenem과 trimethoprim/sulfamethoxazole(STX)을 제외한 대부분의 항균제에 내성을 보였다. 일반병동에서 분리된 11균주 중 9균주는 중환자실에서 분리된 균주와는 서로 다른 PFGE 유형과 항균제 감수성 양상을 보였다. 환경검체 중 사용하던 5개의 소변통과 소독된 1개의 소변통에서 균주가 분리되었으며 imipenem과 STX를 제외한 모든 항균제에 내성을 보였다. 결론：외과계중환자실에서 발생한 다제내성 S. marcescens 집단감염은 단일 클론에 의한 감염임을 확인할 수 있었으며, 감염원은 소변통으로 추정되었다.
Abstract
Background: Serratia marcescens is a well-known cause of nosocomial infections. We investigated an outbreak of S. marcescensinfections in a surgical intensive care unit (SICU) and identified the source of the outbreak using pulsed-field gel electrophoresis (PFGE). Methods: A total of 39 isolates of S. marcescenswere included in this study: 28 isolates from the patients in the SICU and epidemiologically-unrelated 11 isolates from the patients in the general wards from May through August, 2003 at Gyeongsang National University Hospital. Twenty-six of the 28 isolates in the SICU were from the urine collected from indwelling urinary catheters. Fifty-six environmental samples, such as the hands of healthcare workers and urinals were cultured to identify the source of infection. Antimicrobial susceptibility tests by Vitek GNS card (bioMerieux) and PFGE were performed to identify the clonality of the isolates. Results: Twenty of the 28 S. marcescens isolated from the patients in the SICU showed the identical PFGE fingerprint pattern and two isolates had a closely-related pattern with the outbreak strain. The isolates from urine in the SICU were resistant to almost all the antibiotics tested except imipenem and cotrimoxazole. Nine of the 11 isolates from the general wards had PFGE patterns and antimicrobial susceptibility results different from those of the outbreak clone. Five samples from used-urinals and one from disinfected-urinal of 56 environmental samples grew S. marcescensthat were resistant to the all antibiotics tested except imipenem and cotrimoxazole. Conclusion: The outbreak of urinary tract infections in SICU was due to a clonal spread of a single strain of S. marcescens that was multiple resistant to antibiotics except imipenem and cotrimoxazole. The source of outbreak appeared to be inadequately disinfected urinals.
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