임신부의 Group B Streptococci 보균율, 혈청형 및 Macrolide-Lincosamide-StreptograminB 내성형의 분포
Colonization Rate, Serotypes, and Distributions of Macrolide-Lincosamide-StreptograminB Resistant Types of Group B Streptococci in Pregnant Women
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배경: 신생아 GBS 감염 유병률은 임신부의 GBS 보균율이 가장 중요한 결정 요인이다. 우리나라 임신부의 GBS 보균율은 외국에 비해 낮은 것으로 알려져 있으나 이에 대한 최근의 자료가 없는 실정이다. 방법: 2008년 8월부터 2009년 6월까지 분만직전의 임신부를 대상으로 질, 요도구 및 항문주위에서 채취한 면봉 검체를 자가제조한 new Granada 평판배지(NGM-H)와 NGM 튜브 배지(NGM-T), 상품화된 NGM 평판배지(NGM-B) 및 Todd-Hewitt broth (THB) 선택배지에 접종하여 18∼24시간 배양하였다. 분리한 GBS 균주는 한천희석법, 혈청형시험 및 polymerase chain reaction 검사를 시행하였다. 결과: 임신부의 GBS 보균율은 11.5% (27/234)였으며, 검체별로는 항문주위 9.8%, 요도구 8.1%, 질 7.3%의 순이었다. 배지 에 따른 GBS 검출률은 S-THB 96.3%, NGM-B 92.6%, NGM-H 88.9%, NGM-T 85.2%의 순서였다. GBS 혈청형 분포 비율은 III (29.6%), V와 VI (22.2%), Ib와 II (11.1%) 및 Ia (3.7%)의 순서였다. Erythromycin과 clindamycin 내성률은 33.3%와 44.4% 였으며 erythromycin 내성인 9균주에서 8균주는 혈청형 V와 VI으로 erm(B) 내성유전자를 갖고 있었다. 결론: 국내의 임신부 GBS 보균율과 erythromycin과 clindamycin 내성률은 예전에 비해 매우 높아졌으며, erm(B) 유전자를 갖고 있는 V와 VI 혈청형이 새롭게 출현하였다.
Abstract
Background: The prevalence of neonatal group B streptococcal infection depends mainly on the colonization rate of pregnant women by group B streptococci (GBS). Although the colonization rate of Korean women by GBS is considered lower than in other countries, recent data on the maternal colonization rate of GBS are sparse. Methods: From August 2008 to June 2009, swab specimens from the anorectus, vagina, and urethral orifice of a sample of 234 pregnant Korean women were placed in new Granada medium (NGM-H), tube medium (NGM-T), commercial NGM (NGM-B), and selective Todd-Hewitt broth (S-THB) for 18∼24 hours in 5% CO2 at 35oC. Agar dilutional antimicrobial susceptibility tests, serotyping, and PCR were performed for GBS isolates. Results: The colonization rate of GBS in pregnant women was 11.5% (27/234). Of the specimen cultures, 9.8% of anorectal cultures were positive, 8.1% of urethral orifice cultures were positive, and 7.3% of vagina cultures were positive. The detection rate of GBS in the different culture media was S-THB (96.3%), NGM-B (92.6%), NGM-H (88.9%), and NGM-T (85.2%). The distribution of GBS serotypes was as follows: III (29.6%), V and VI (22.2%), Ib and II (11.1%), and Ia (3.7%). 33.3% of GBS isolates were resistant to erythromycin and 44.4% to clindamycin. Among the nine erythromycin-resistant isolates, eight were serotype V and VI, which are erm(B) positive serotypes. Conclusion: The colonization of pregnant women by GBS, and the incidence of resistance of the GBS isolates to erythromycin and clindamycin were higher than those previously reported. Serotypes V and VI, GBS serotypes that carry the erm(B), are novel serotypes that have not previously been identified in pregnant Korean women.
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