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지역사회 기질확장성 베타락타메이즈 생성 대장균의 확산 상황에서 집단발생이 없는 중환자실 내원환자의 적극적 감염감시 배양의 유용성

The Usefulness of Active Surveillance Culture of Extended-Spectrum β-Lactamase-Producing Escherichia coli in ICU Settings without Outbreak in the Situation of Wide Spread of Sequence Type 131 ESBL-Producing E. coli in Community

박윤수
대한임상미생물학회 (Korean Society of Clinical Microbiology)|2018.06|Annals of Clinical Microbiology|제21권 제2호|pp. 28-35

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PrevalenceEscherichia coliSequence type 131Extended-spectrum β- lactamase

초록

배경: 본 연구의 목적은 지역사회에 ST131 extended-spectrum β-lactamase (ESBL) 생성 Escherichia coli의 확산으로 의료기관의 노출이 없어도 보균 가능성이 높은 현 시점에서 중환자실 내원 환자의 ESBL 생성 E. coli 보균 현황과 적극적 감염감시 배양의 유용성을 새롭게 평가해 보고자 한다. 방법: 연속적이고 전향적으로 2016년 5월부터 6월까지 중환자실에 입원한 모든 환자들(총 281명)를 대상으로 입실 48시간 이내에 적극적 감염감시 배양을 시행하여 ESBL 생성 E. coli 보균 여부를 확인하였다. ESBL 유전자형은 PCR과 염기서열 분석으로 하였고, O16-ST131/O25-ST131을 PCR로 확인하였다. 환자-대조군 연구를 통해 위험인자 분석을 하였다. 결과: 중환자실 입실 48시간 내 환자에서 ESBL 생성 E. coli 보균율은 14.9% (42/281)였고, 흔한 ESBL 유전자형은 CTX-M-15 (N=15), CTX-M-14 (N=12) 및 CTX-M-27 (N=10)이었다. ESBL 생성 E. coli의 45.2% (19/42)가 sequence type (ST) 131 clone으로 ST131-O25 14주 및 ST131-O16 5주였다. 중환자실 ESBL 생성 E. coli 획득의 위험인자로는 내과계 중환자실 입원이었고(odds ratio, 2.05; P=0.032), 획득 경로, 이전 항균제 사용 및 재원 일수는 유의한 위험인자가 아니었다. 결론: 결론적으로 저자들은 의료기관의 노출력 없이도 중환자실 내원 환자의 ESBL 생성 E. coli 보균 가능성이 높은 것을 확인 하였다. 국내 지역사회 ESBL 생성 E. coli의 확산 현황을 고려하면 집단 발생이 없는 상황에서도 중환자실 내원 환자를 대상으로 ASC를 시행하는 것이 ESBL 생성 E. coli 보균여부를 확인하고 감염원을 관리하는 목적으로 충분한 가치가 있다고 판단되었다. [Ann Clin Microbiol 2018;21:28-35]

Abstract

Background: In the present study, the prevalence and risk factors for acquisition of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli in intensive care unit (ICU) settings without outbreak in the situation of widespread sequence type (ST) 131 ESBL-producing E. coli in a Korean community was investigated. Methods: Consecutive and prospective screening of ESBL-producing E. coli colonization was performed in all patients admitted to surgical or medical ICUs within 48 hours for two months. ESBL genotype was determined based on PCR and sequencing. PCR for O16-ST131/O25-ST131 was performed for all ESBL producers. Clinical information was obtained from a review of electronic medical record to determine the risk factors for ESBL-producing E. coli colonization. Results: The colonization rate of ESBL-producing E. coli at ICU admission was 14.9% (42/281). CTX-M-15 (N=15), CTX-M-14 (N=12), and CTX-M-27 (N=10) were commonly detected using PCR of ESBL genes. Approximately half (45.2%, 19/42) of ESBL producers were ST131 clone with 14 ST131-O25 and 5 ST131- O16. In univariate analysis, independent risk factor for acquisition of ESBL-producing E. coli compared with controls was ICU type (odds ratio, 2.05; P＜ 0.032); however, site of acquisition, previous antibiotic use, and hospital stay were not significant risk factors. Conclusion: In this study, the colonization of ESBL- producing E. coli at ICU admission without outbreak was frequent and it could be an infection source, regardless of acquisition site. We recommend routine use of ASC to control endemic ESBL-producing E. coli considering the wide distribution of ST131-ESBL- producing E. coli in the Korean community. (Ann Clin Microbiol 2018;21:-35)

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