2014년에서 2017년까지 요양병원에서 분리한 세균의 항균제 내성
Antimicrobial Resistance in Bacterial Isolates Recovered from Nursing Hospitals between 2014 and 2017
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배경: 요양병원의 기관 수가 늘고 있으나, 요양병원 환자에서 분리된 병원균의 항균제 내성률에 대한 감시 결과가 미비하여 이에 대한 연구가 필요한 바, 국내의 한개 수탁기관에 의뢰된 시험결과를 바탕으로 요양병원의 항균제 내성 현황을조사하였다. 방법: 2014년 1월부터 2017년 12월까지 4년간, 61개 요양병원 환자로부터 분리한 총 23,518개 균주의 감수성검사 결과를분석하였다. VITEK 2 장비를 사용하여 검사하였으며, 균종에 적합한 항균제 감수성 시험 카드를 이용하였다. 결과: 총 19,357주의 그람음성세균과 4,161주의 그람양성세균이 분리되었다. 그람음성세균 중에는 Pseudomonas aeruginosa (n=6,384)와 Escherichia coli (n=5,468), 그람양성세균 중에는 Staphylococcus aureus (n=1,565)가 가장 많이 분리된 균종이었다. 주요 내성세균의 분리비율은 높은 편으로, 2017년 분리균의 cefotaxime 내성률은 Klebsiella pneumoniae에서77.4%, E. coli에서 70.6%였으며, imipenem 내성률은 Acinetobacter baumannii에서 90.3%, P. aeruginosa에서 49.3%, oxacillin 내성률로 추정된 S. aureus의 methicillin 내성률은 81.1%, Enterococcus faecalis의 penicillin 내성률은 44.8%, Enterococcus faecium의 vancomycin 내성률은 53.5%에 달했다. 내성률의 연도별 변화 추이는 균종별, 항균제별로 다양하였다. 결론: 본 연구를 통해 요양병원 환자에서 분리된 세균의 주요 항균제에 대한 내성률이 imipenem 내성 A. baumannii를제외한 모든 경우에 종합병원에 비해 높음을 확인할 수 있었고, 요양병원의 항균제 내성에 대한 지속적인 감시와 연구를통한 적절한 항균제 사용과 감염관리의 중요성을 확인할 수 있었다. [Ann Clin Microbiol 2019;22:96-104]
Abstract
Background: Antimicrobial resistance (AMR) is an issue not only with regard to public health, but also in terms of economic impact. AMR surveillance has mainly been carried out in general hospitals, and not in nursing hospitals. This study was conducted to investigate the AMR rate for bacterial strains isolated from nursing hospital samples. Methods: Antimicrobial susceptibility testing (AST) results from a total of 23,518 bacterial isolates recovered from clinical specimens taken in 61 nursing hosals were analyzed. AST was conducted using Vitek 2 with AST cards specific for the bacterial strains. Results: A total of 19,357 Gram-negative and 4,161 Gram-positive bacterial strains were isolated. Pseudomonas aeruginosa (n=6,384) and Escherichia coli (n= 5,468) were the most prevalent bacterial species and, among Gram-positive bacteria, Staphylococcus aureus (n=1,565) was common. The AMR rate was high for the following strains: cefotaxime-resistant Klebsiella pneumoniae, 77.4%; cefotaxime-resistant E. coli, 70.6%; imipenem-resistant Acinetobacter baumannii, 90.3%; imipenem-resistant P. aeruginosa, 49.3%; oxacillin- resistant S. aureus, 81.1%, penicillin-resistant Enterococcus faecalis, 44.8%, and vancomycin-resistant Enterococcus faecium, 53.5%. AMR rate change varied by bacterial species and antimicrobial drug. Conclusion: AMR rates of major pathogens from nursing hospitals were higher than those from general hospitals with the exception of imipenem-resistant A. baumannii. Continuous monitoring and infection control strategies are needed. (Ann Clin Microbiol 2019;22:96-104)
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