CTX-M-12, PER-1 및 OXA-30 β-Lactamase 생성 Klebsiella pneumoniae의 출현
Emergence of CTX-M-12, PER-1 and OXA-30 -Lactamase-Producing Klebsiella pneumoniae
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배경：Ceftazidime 또는 cefotaxime 내성 Klebsiella pneumoniae를 대상으로 Ambler class A형 및 D형 extended-spectrum β-lactamase (ESBL)의 생성현황을 조사하고자 하였다. 방법：2005년 5-6월에 전국 11개 병원에서 분리된 ceftazidime 또는 cefotaxime 내성 K. pneumoniae 를 수집하였다. Ceftazidime 또는 efotaxime에 대한 감수성을 디스크 확산법으로 시험하였으며, ESBL 생성은 double-disk synergy 시험으로 조사하였다. ESBL 생성균주의 ceftazidime 또는 cefotaxime 내성을 접합으로 내성 수여자인 azide 내성 E. coli J53으로 전달하였다. PCR로 Ambler class A형 및 D형 ESBL을 생성하는 유전자를 검출하였고, PCR 산물의 염기서열을 양방향으로 분석하였다. 결과：ESBL 유전자 PCR 산물의 염기서열 분석결과 blaSHV-12를 지닌 균주가 148주로 가장 흔하였으며, 이 외에도 blaSHV-2a (2주), blaTEM-52 (1주), blaCTX-M-3 (15주), blaCTX-M-9 (6주), blaCTX-M-12 (2주), blaCTX-M-14 (9주), blaCTX-M-15 (1주), blaGES-5 (3주), blaPER-1 (1주) 및 blaOXA-30 (2주)이 확인되었다. 결론：본 연구를 통하여 PER-1, CTX-M-12, OXA-30 등 국내에서 분리되는 K. pneumoniae가 생성하는 ESBL의 종류가 다양해지고 있음을 확인할 수 있었다.
Abstract
Background: The aim of this study was to determine a nation-wide prevalence of Ambler class A and D extended-spectrum -lactamases (ESBL) in Klebsiella pneumoniae isolates in Korea. Methods: During the period of April to May 2005, 189 isolates of K. pneumoniae were collected from 11 Korean hospitals. Antimicrobial susceptibilities to ceftazidime and cefotaxime were tested by the disk diffusion method, and ESBL production was determined by double-disk synergy test. Determinants of ceftazidime or cefotaxime-resistance were transferred to Escherichia coli J53 (azide-resistant) by transconjugation. Genotypes of class A and D ESBL genes were determined by PCR amplification and sequencing. Results: One hundred-sixty isolates of K. pneumoniae showed positive results in double-disk synergy test. The most prevalent ESBL was SHV-12 (n=148). Also detected were genes encoding ESBLs including TEM-52 (n=1), SHV-2a (n=2), CTX-M-3 (n=15), CTX-M-9 (n=6), CTX-M-12 (n=2), CTX-M-14 (n=9), CTX-M-15 (n=1), PER-1 (n=1), GES-5 (n=3), and OXA-30 (n=2) -lactamases. Conclusion: With the emergence of CTX-M-12, PER-1, and OXA-30 -lactamases, the ESBLs in K. pneumoniae isolates are becoming more diverse in Korea.
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