Extended Spectrum β-Lactamase를 생성하는 Escherichia coli,Klebsiella species 및 Proteus mirabilis 의 분리빈도
Isolation Frequency of Extended Spectrumβ-Lactamase Producing Escherichia coli,Klebsiella species, and Proteus mirabilis
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배경: Extended spectrum β-lactamase (ESBL)를 생성하는 세균은 감수성검사에서 oxyimino-β-lactam 계열 약물에 감수성을 보일 수 있으나 임상적으로는 효과가 없기 때문에 ESBL 생성 균주의 정확한 검출은 매우 중요하다. 또한 ESBL 생성 균주의 분리 추이의 지속적인 조사는 항균제 사용 지침과 병원감염관리의 방향을 설정하는 데도 필수적이다. 방법: 2001년 4월부터 2007년 3월까지 6년간 임상검체에서 분리된 Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca 및 Proteus mirabilis 5,511 균주를 대상으로 Clinical and Laboratory Standards Institute (CLSI)의 extended spectrum β -lactamase (ESBL) 디스크확인시험에 따라 cefotaxime과 cefotaxime/clavulanic acid (CTC), ceftazidime과 ceftazidime/clavulanic acid (CZC)의 억제대를 비교하여(각각 CTC 확인시험, CZC 확인시험) 한 가지라도 clavulanic acid에 의해 5 mm이상 억제대가 증가되는 균종을 ESBL 양성으로 정의하였다. 결과: K. pneumoniae, K. oxytoca, E. coli와 P. mirabilis의 양성률은 각각 34.8%, 9.3%, 8.4% 및 6.5%였다. ESBL 양성 균주의 ESBL CTC 및 CZC 확인시험의 양성률 K.pneumoniae가 91.3%와 68.7%, K. oxytoca는 96.3%와 44.4%, E. coli는 94.8%와 45.4%, P. mirabilis는 100%와 20%였다. K. pneumoniae는 2001년의 24.3%에서 2006년의 46.4%로 ESBL 양성률이 지속적으로 증가하였다. 결론: E. coli, K. pneumoniae, K. oxytoca와 P. mirabilis의 ESBL을 검출하기 위해서는 두 종류의 ESBL 확인시험을 병행해야 하며, ESBL 생성 K. pneumoniae에 대한 적극적인 감염관리대책이 필요할 것으로 생각되었다.
Abstract
Background: Accurate detection of extended spectrum β-lactamase (ESBL) is important because ESBLproducing organisms may appear susceptible to oxyimino- β-lactams in standard susceptibility tests, but are considered to be clinically resistant to these drugs. And continued monitoring of isolation trend of ESBL-producing organisms is essential for the guideline settlement of antibiotic usage and infection control program. Methods: Disk diffusion test using the Clinical and Laboratory Standards Institute's ESBL phenotypic confirmatory test were performed on 5,511 clinical isolates of Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca, and Proteus mirabilis during the recent six years (April 2001-March 2007). The ESBL producer was defined as an organism showing an increase in the zone diameter of ≥5 mm for either cefotaxime or ceftazidime with clavulanic acid versus that without clavulanic acid (CTC confirmatory test, CZC confirmatory test, respectively). Results: The ESBL-positive rates were 34.8% in K. pneumoniae, 9.3% in K. oxytoca, 8.4% in E. coli, and 6.5% in P. mirabilis. Among the ESBL-positive organisms, the detection rates of ESBL CTC and CZC confirmatory tests were as follows: 91.3% vs 68.7% in K. pneumoniae, 96.3% vs 44.4% in K. oxytoca, 94.8% vs 45.4% in E. coli, and 100% vs 20% in P. mirabilis. ESBL-producing K. pneumoniae had shown a continuously increasing trend from 24.3% in 2001 to 46.4% in 2006. Conclusion: Both of the ESBL confirmatory tests should be simultaneously tested for the accurate detection of ESBL-producing K. pneumoniae, K. oxytoca, E. coli, and P. mirabilis. In addition, an active infection control approach is needed for ESBL-producing K. pneumoniae.
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