2013년 국내 분리 임균의 항균제 내성 현황과 분자역학적 특성
Antimicrobial Resistance and Molecular Epidemiologic Characteristics of Neisseria gonorrhoeae Isolated from Korea in 2013
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배경: 임균의 항균제 내성은 심각하며, 최근 3세대 cephalosporins제에 비감수성인 균주가 일본과 유럽에서 보고되었다. 본 연구에서는 2013년 국내 환자에서 분리된 임균의 항균제 내성 현황과 분자 역학적 특성을 평가하였다. 방법: 국내 환자와 특수직업여성으로부터 총 60균주가 수집되었다. 모든 균주를 대상으로 디스크 확산법과 한천희석법으로 항균제 감수성 시험을 하였다. 분자역학적 조사를 위해 Neisseria gonorrhoeae multi-antigen sequence typing (NG-MAST)을 시행하였다. 결과: 한천희석법을 이용한 감수성 검사에서 penicillin G 및 tetracycline에 감수성인 균주는 없었으며, ciprofloxacin에 내성인 균주의 비율은 95%로 높았다. Cefixime에 1주가 내성이었고, ceftriaxone에 모두 감수성이었으며, 감수성저하 균주(MIC≥0.12 μg/mL)의 비율은 각각 10%와 14%였다. NG-MAST 분석 결과 59 균주에서 40개의 서로 다른 sequence type이나왔으며 그 중 18개는 본 연구에서 새로 발견된 ST였다. tbpB110 유전자형을 가진 균주의 경우 cefixime과 ceftriaxone에비교적 높은 MIC (0.12-0.5 μg/mL)를 보였다. 결론: 2013년에 국내에서 분리된 임균은 penicillin G, tetracycline 및 quinolone에는 대부분 내성을 보였지만, spectinomycin 과 cephalosporin에는 감수성이었다. 그러나 cefixime 비감수성 균주가 분리되었고, cephalosporin 내성과 관련 있는 ST1407 과 동일한 tbpB110 유전자형을 가진 균주가 관찰되어, N. gonorrhoeae의 cephalosporin 내성 출현을 모니터링 하기 위한지속적인 감시 시스템이 필요하다고 판단된다.
Abstract
Background: Antimicrobial resistance of Neisseria gonorrhoeae has become a serious problem worldwide,and ceftriaxone non-susceptible isolates have been recently reported from Japan and Europe. In this study, we evaluated the antimicrobial susceptibilities and molecular epidemiological characteristics of isolates from Korea in 2013. Methods: Sixty strains of N. gonorrhoeae were collected from Korean patients and prostitutes. Antimicrobial susceptibility was tested by the agar dilution and disk diffusion methods. N. gonorrhoeae multi-antigen sequence typing (NG-MAST) was performed in order to determine the molecular epidemiologic relatedness. Results: All of isolates were non-susceptible to penicillin G and tetracycline, and the rate of ciprofloxacinresistant isolates was 95% in 2013. The MICs of ceftriaxone were within the susceptible range for all isolates,but one isolate non-susceptible to cefixime (MIC=0.5 μg/mL) was encountered. The isolates with decreased susceptibility (MIC≤0.12 μg/mL) to cefixime or ceftriaxone accounted for 10% and 14% of the isolates tested, respectively. In NG-MAST analysis,40 different STs were encountered among the 59isolates. Isolates that belonged to tbpB110 showed higher cefixime and ceftriaxone MICs (0.12-0.5 μg/mL) as well as cefixime resistance. Conclusion: Most of the N. gonorrhoeae isolates showed susceptibility to spectinomycin and cephalosporins. Due to the emergence of isolates that are non-susceptible to cefixime and the prevalence of isolates with the tbpB110 allele belonging to ST1407, which cause cefixime and ceftriaxone treatment failure in successful global clones of N. gonorrhoeae, a continuous nationwide antimicrobial surveillance program is required to monitor the emergence of cephalosporin resistance in N. gonorrhoeae.
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