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Ambler Class A Extended-Spectrum β-Lactamase 생성 Escherichia coli와 Klebsiella pneumoniae의국내분리현황

Prevalence of Ambler Class A Extended-Spectrum β-Lactamase-Producing Escherichia coli and Klebsiella pneumoniae Isolates in Korea

이종욱|이경원|안지영|홍성근|박연준|정석훈|어영|김의종|신종희|용동은|이위교|강정옥|배일권|우건조|권수봉|강지혜
대한임상미생물학회 (Korean Society of Clinical Microbiology)|2005.04|Annals of Clinical Microbiology|제8권 제1호|pp. 17-25

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초록

배경：본 연구에서는 국내에서 분리되는 Escherichia coli와 Klebsiella pneumoniae의 Ambler class A extended-spectrum β-lactamase (ESBL) 생성 현황을 알아보고자 하였다. 방법：2003년 2월부터 7월까지 전국 12개 병원에서 분리된 E. coli와 K. pneumoniae를 수집하였다. 항균제 감수성은 디스크 확산법으로 시험하였고, ESBL 생성은 double-disk synergy 시험으로 확인하였다. 한천희석법으로 β-lactam 항균제의 최소억제 농도를 측정하였다. 중합연쇄반응으로 TEM형, SHV형, CTX-M형, PER-1형, VEB형, IBC형, GES형 및 TLA형 유전자를 검출하였고, 중합연쇄반응 산물의 염기서열을 양방향으로 분석하였다. 결과：국내 12개 병원에서 수집한 E. coli와 K. pneumoniae의 ceftazidime에 대한 내성율은 각각 8.5%와 20.1%이었다. E. coli에서 가장 흔한 Ambler class A ESBL은 CTX-M-15 (4주)와 CTX-M-3 (3주)였으며, CTXM-14, SHV-12 및 TEM-52 유전자를 지닌 균주 각 1주씩 검출되었다. K. pneumoniae에서 가장 흔한 ESBL은SHV-12 (30주)와 CTX-M-3 (13주)였으며, CTX-M-14 (5주), SHV-2a (3주), SHV-5 (2주), TEM-52 (1주) 및 GES-3 (2주) 유전자를 지닌 균주도 검출되었다. 결론：본 연구를 통하여 CTX-M형 ESBL을 생성하는 E. coli와 K. pneumoniae가 국내에서 확산중이며 GES-3형 ESBL의 출현을 확인할 수 있었다.

Abstract

Background: The aim of this study is to determine the nationwide prevalence of Ambler class A extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae and to characterize genotypes of ESBLs. Methods: During the period of February through July, 2003, E. coliand K. pneumoniae isolates were collected from 12 hospitals in Korea. Antimicrobial susceptibilities were tested by disk diffusion method, and ESBL-production was determined by the double-disk synergy test. MICs of β-lactam antibiotics were tested by agar dilution method. Searches for blaTEM, blaSHV, blaCTX-M, blaPER-1, bla-VEB, blaIBC, blaGES and blaTLA genes were performed by PCR amplification, and the genotypes of ESBLs were determined by direct nucleotide sequence analysis of amplified products. Results: Resistance rates of E. coli (n=246) and K. pneumoniae (n=239) isolates to ceftazidime were 8.5% and 20.1%, respectively. Most prevalent Ambler class A ESBL genotypes in E. coliisolates were blaCTX-M-15 (n=4) and blaCTX-M-3 (n=3), and each of blaCTX-M-14, blaSHV-12, and blaTEM-52 gene was also found in one isolate. Most prevalent ESBL genotypes in K. pneumoniae were blaSHV-12 (n=30) and blaCTX-M-3 (n=13), and blaCTX-M-14 (n=5). blaSHV-2a (n=3), blaSHV-5 (n=2), blaTEM-52 (n=1), blaGES-3 (n=2) genes were also found. Conclusion: CTX-M-type ESBL-producing E. coli and K. pneumoniae isolates are spreading, and a GES-type ESBL has emerged in Korea.

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