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2004년 진주지역에서 분리된 Streptococcus pyogenes의 Erythromycin 내성률 감소

A Decrease in Erythromycin Resistance Rate of Streptococcus pyogenes in 2004 in Jinju

김선주|정현주|이남용|고은하|맹국영
대한임상미생물학회 (Korean Society of Clinical Microbiology)|2006.04|Annals of Clinical Microbiology|제9권 제1호|pp. 51-57

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초록

배경：Streptococcus pyogenes의 erythromycin (EM) 내성률은 지역이나 조사시기에 따라 다른데 우리나라에서는 한 지역을 대표할 만한 지속적인 조사가 거의 없었다. 본 연구에서는 진주지역에서 2천명 이상의 초등학생을 대상으로 S. pyogenes를 분리하여 EM 내성률과 내성기전을 알아보고 이전 결과와 비교하였다. 방법：2004년 10월에서 12월까지 경남 진주지역에 위치한 네 개의 초등학교를 방문하여 상기도 감염 증상이나 징후가 없는 초등학생 2,351명을 대상으로 인두배양을 실시하였다. S. pyogenes로 동정된 328균주를 대상으로 한천희석법을 실시하여 6종의 항균제에 대한 내성률을 알아보았다. 이중디스크 확산법으로 EM 내성표현형을 알아보았고 중합효소연쇄반응을 이용하여 EM 내성유전자 양성률을 조사하였다. 결과：항균제 감수성 검사 결과 EM 내성률은 9.8%이었으며 clindamycin과 tetracycline 내성률은 각각 8.8%와 18.3%이었다. Ofloxacin, levofloxacin 및 chloramphenicol에는 대부분 감수성이었다. EM 내성균의 표현형 분포는 구성형이 87.5%이었으며, M형이 9.4%, 유도형이 3.1%이었다. EM 내성유전자 양성률은 ermB가 90.6%, mefA가 9.4%이었다. 결론： S. pyogenes의 EM 내성률은 9.8%로 2002년의 51%에 비해 현저히 낮아졌으나, ermB 양성인 구성형이 90.6%로 EM 내성균의 대부분이 고도내성균임을 시사하였다.

Abstract

Background: The erythromycin (EM) resistance rates and emm genotypes of Streptococcus pyogenes could vary by geographical location and study period. The purpose of this study, involving a large number of children, was to determine EM resistance rate and its resistance mechanism of S. pyogenes, and to compare these results with those of previous studies performed at the same area. Methods: Throat cultures were taken from 2,351 healthy children of four elementary schools from October through December, 2004 in Jinju. A total of 328 strains of S. pyogenes were isolated. Antimicrobial susceptibility test was performed by the agar dilution method against six antimicrobial agents. The phenotypes of EM resistance were evaluated by the double-disk diffusion test and the frequency of ermB and mefA genes was determined by polymerase chain reaction. Results: Resistance rates of S. pyogenes to EM, clindamycin and tetracycline were 9.8%, 8.8% and 18.3%, respectively. Almost all isolates were susceptible to ofloxacin, levofloxacin and chloramphenicol. Constitutive resistance (CR) was observed in 87.5%, M phenotype in 9.4%, and inducible resistance only in 3.1%. The ermB and mefA genes were present in 90.6% and 9.4% of the isolates, respectively. Conclusion: The resistance rate to EM of S. pyogenes was 9.8% in 2004, which was a large drop from the 51% shown in 2002. CR with the ermB gene was predominant, suggesting that most of the EM resistant isolates have a high level of resistance.

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