국내 여성 질-회음부에서 분리된 Group B Streptococcus (GBS) 보균율 및 항균제 감수성
Perineal Colonization Rate and Antimicrobial Susceptibility of Group B Streptococcus in Pregnant and Non-Pregnant Korean Women
3
조회
0
다운로드
4
인용
0
참고문헌
키워드
초록
배경: Group B streptococcus (Streptococcus agalactiae, GBS)는 신생아 패혈증 및 뇌막염의 주요한 원인균으로 보균상태인 임산부로부터 신생아에게 수직 감염되는 것으로 알려져 있다. GBS는 penicillin 내성이 거의 없는 것으로 알려져 있었으 나 최근 penicillin 비감수성 균주의 출현 및 erythromycin, clindamycin 내성균의 증가가 우려되고 있다. 따라서 본 연구에 서는 임신부를 포함한 여성을 대상으로 GBS의 질 및 회음부의 보균율을 알아보고, 다양한 항균제에 대한 항균제 감수성 률을 파악해 보았다. 방법: 2008년 5월부터 2009년 1월까지 두 대학병원과 한 임상검사센터에서 산모를 포함한 가임기 여성의 질 및 회음부 면봉 검체 및 신생아에서 분리된 180건의 GBS균주에 대해서 디스크확산법 및 broth microdilution 법을 이용한 항균제 감수성 검사를 시행하였으며, erythromycin 내성 균주의 유전자형 검사를 PCR방법으로 시행하였다. 결과: 가임기 여성의 질 및 회음부 GBS 보균율은 5.5∼7.5%, 산모에서의 보균율은 5.5∼6.3%였다. 항균제 감수성 검사상 penicillin에 모두 감수성이었으며, clindamycin 및 erythromycin 내성률은 41.1%, 27.8%였다. Erythromycin 내성유전자 검사 결과 ermB 유전자가 40건으로 가장 많이 분리되었으며, 표현형으로는 구성형 cMLSB 내성이 가장 많았다. 결론: 국내 가임기 여성 생식기에서의 GBS 보균율 및 erythromycin, clindamycin 내성률이 증가 추세로 나타나므로, 향후 지속적으로 GBS 보균율 및 항균제 내성 양상을 파악하고, 추이를 관찰하는 것이 신생아 감염예방 및 내성균 관리를 위해 필요하다고 생각한다.
Abstract
Background: Group B Streptococcus (Streptococcus agalactiae, GBS) is a major cause of severe infections in neonates, including bacteremia, pneumonia, and meningitis, and is generally vertically transmitted from a colonized, pregnant woman to her infant. Penicillin is the drug of choice to treat GBS infections, because GBS strains are uniformly susceptible to penicillin. Recently, however, penicillin resistant GBS strains have been reported and the rates of erythromycin and clindamycin resistance have increased. We evaluated the perineal colonization rates and antimicrobial susceptibility of GBS strains isolated from pregnant and non-pregnant women. Methods: The antibiotic susceptibilities of a total of 180 GBS strains isolated from two university hospitals and one reference laboratory between May 2008 and January 2009 were determined using disk diffusion and broth microdilution methods. The presence of erythromycin resistance genes was confirmed by PCR. Results: The average colonization rate of pregnant women was 5.5%. The overall colonization rates of pregnant and non-pregnant women ranged between 5.5% and 7.5%. All 180 GBS strains were susceptible to penicillin. Fifty strains (27.8%) were resistant to erythromycin, whereas 78 (41.1%) were resistant to clindamycin. The ermB gene was identified in 40 isolates and 44 isolates had constitutive macrolidelincosamide- streptogramin B resistance phenotypes. Conclusion: Our findings indicate an increased GBS colonization rate and an increase in macrolide resistance in GBS strains in recent years, emphasizing the need for further surveillance and continual monitoring of antimicrobial susceptibility.
참고문헌 (18)
- Uh Y, "Colonization rate of Group B Streptococcus in pregnant women and neonates", Korean J Clin Pathol, 14, pp.447~453 (1994)
- Kimura K, "First molecular characterization of Group B streptococci with reduced penicillin susceptibility", Antimicrob Agents Chemother, 52, pp.2890~2897 (2008)
- Castor ML, "ntibiotic resistance patterns in invasive group B streptococcal isolates", Infect Dis Obstet Gynecol, 2008, pp.727505~ (2008)
- Kimura K, "Emergence of penicillin-resistant group B streptococci", ICAAC, C2, pp.1286~ (2006)
- 김효열, "Macrolide Resistance in B-Hemolytic Streptococci: Changes after the Implementation of the Separation of Prescribing and Dispensing of Medications Policy in Korea", Yonsei Medical Journal, 45(4), pp.591~597 (2004), 연세대학교의과대학
- Ruess M, "Antimicrobial susceptibility patterns of Streptococcus agalactiae in a German university hospital", Scand J Infect Dis, 32, pp.623~626 (2000)
- Performance standards for antimicrobial susceptibility testing, "Clinical", CLSI, ~, pp.CLSI document M100-S18 (2008)
- Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically; approved standard, "Clinical", CLSI, ~, pp.CLSI document M7-A7 (2006)
- Dahesh S, "Point mutation in the group B streptococcal pbp2x gene conferring decreased susceptibility to β-lactam antibiotics", Antimicrob Agents Chemother, 52, pp.2915~2918 (2008)
- de Azavedo JCS, "revalence and mechanisms of macrolide resistance in invasive and noninvasive group B streptococcus isolates from Ontario, Canada", Antimicrob Agents Chemother, 45, pp.3504~3508 (2001)
- Yi KS, "Trend in the isolation of β-hemolytic streptococci and current infection status of group B streptococcus", Korean J Clin Pathol, 21, pp.365~370 (2001)
- Simoes JA, "Antibiotic resistance patterns of group B streptococcal clinical isolates", Infect Dis Obstet Gynecol, 12, pp.1~8 (2004)
- Iimura T, "Group B streptococcal infection", Modern Media, 25, pp.505~519 (1979)
- Schuchat A, "Group B streptococcus", Lancet, 353, pp.51~56 (1999)
- Betriu C, "Antibiotic resistance and penicillin tolerance in clinical isolates of group B streptococci", Antimicrob Agents Chemother, 38, pp.2183~2186 (1994)
- Morikawa Y, "Prevalence of cefotaxime resistance in group B streptococcus isolates from Osaka, Japan", J Infect Chemother, 9, pp.131~133 (2003)
- 어영, "Macrolide Resistance Trends in β-Hemolytic Streptococci in a Tertiary Korean Hospital", Yonsei Medical Journal, 48(5), pp.773~778 (2007), 연세대학교의과대학
- Desjardins M, "Prevalence and mechanisms of erythromycin resistance in group A and group B streptococcus: implications for reporting susceptibility results", J Clin Microbiol, 42, pp.5620~5623 (2004)