다제내성세균에 대한 적극적 감염감시
Active Surveillance for Multidrug-resistant Organisms
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초록
메티실린내성황색포도알균과 반코마이신내성장알균 등의 다제내성세균에 의한 감염과 집단감염이 증가하고 있다. 내성세균의 검출 방법의 경우 전통적인 배양법에서 발색배지를 이용한 배양법과 분자진단법으로 발전되어 왔으며, 다양한분자기법을 통한 균주형별분류는 역학적인 감염감시에서 중요한 위치를 차지하고 있다. 뿐만 아니라 집단감염을 발견하는 체계는 전통적인 수동적 감염감시에서 적극적 감염감시 및 증후군적 감시 등으로 발전되어 왔다. 그러나 다제내성세균의 관리라는 당면한 문제 앞에 이러한 다양한 도구를 효과적으로 사용하기 위한 지침과 제도를 구축하는 것은 쉽지않은 일이다. 최적의 감염감시체계를 구축하기 위해서는 임상미생물학자를 비롯한 의료관련감염 전문가와 정책입안자가 함께 고민하고 해결방안을 모색하여야 한다. 또한 내성세균의 감시와 관련한 전문 지식을 숙지하고 내성세균의 관리에 필요한 다양한 고려사항에 대한 충분한 토의를 거쳐 순차적으로 체계를 확립해가는 과정이 필수적일 것으로 판단된다.
Abstract
Infections and outbreaks of antimicrobial-resistant bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE), have been increasing. Detection methods for antimicrobial-resistant bacteria have been changed from traditional culture methods to chromogenic media culture and molecular methods. Straintyping methods using various molecular technologies are essential tools for epidemiologic surveillance. Furthermore, outbreak detection, using syndromic surveillance as well as passive and active surveillance, has been applied. However, it is difficult to establish effective and robust guidelines and systems for using these various methods to control antimicrobial-resistant bacteria. Therefore, clinical microbiologists and policy makers must possess expertise in the control of antimicrobial resistant bacteria, discuss the issue sufficiently, and, finally, create a system to accomplish this control.
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