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최근 4년간 대전지역에서 분리된 KPC-2 생성 Klebsiella pneumoniae의 역학적 연구

Epidemiological Study of KPC-2 Producing Klebsiella pneumoniae Isolated in Daejeon During a 4-Year Period

조혜현
대한임상검사과학회 (Korean Society for Clinical Laboratory Science)|2022.12|대한임상검사과학회지 (Korean Journal of Clinical Laboratory Science)|제54권 제4호|pp. 265-272|DOI 10.15324/kjcls.2022.54.4.265

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키워드

Klebsiella pneumoniaeCarbapenemaseBeta-lactamase KPC-2
주제분류기타자연과학

초록

Carbapenemase 생성 장내 세균(carbapenemase-producing Enterobacteriaceae, CPE) 중 특히 KPC-2 생성 Klebsiella pneumoniae의 출현과 확산은 전 세계적으로 급격히 증가하고 있으며, 심각한 공중 보건 위협이 되고 있다. 이러한 KPC-2 생성 K. pneumoniae의 역학과 특징은 지역 및 기간에 따라 다르기 때문에, 본 연구에서는 2017년 3월부터 2020년 12월까지 대전지역의 3차 병원에서 분리된 carbapenem 내성K. pneumoniae (carbapenem-resistant K. pneumoniae, CRKP) 78 균주를 대상으로 carbapenemase 유전자를 분석하고, 이에 대한 역학 관계를 조사하였다. 항균제 감수성 양상은디스크 확산법으로 확인하였고, carbapenemase 유전자의 분석을 위해 PCR과 DNA 염기서열분석을 수행하였다. 또한, 역학관계는 MLST (multilocus sequence typing)를 통해 조사하였다. 78 균주의 CRKP 중 35 균주(44.9%)가 carbapenemase 생성 K. pneumoniae였으며, 주요 carbapenemase 유형은 KPC-2 (30주, 85.7%)로 확인되었다. NDM-1과 NDM-5는 각각 4 균주(11.4%)와 1 균주(2.9%)에서 확인되었다. MLST 분석에서 10개의 sequence type (ST)이 확인되었고, 가장 흔한 ST는 ST307 (51.4%, 18/35)이었다. ST307 균주는 모두 KPC-2 생성K. pneumonia였고, 다제내성으로 확인되었다. 또한, ST307은4년 동안 지속적으로 출현하였다. 이러한 결과는 KPC-2 생성 K. pneumoniae ST307의 확산을 방지하기 위해 지속적인 모니터링과 적절한 감염 관리가 필요할 것으로 사료된다.

Abstract

The emergence and dissemination of carbapenemase-producing Enterobacteriaceae (CPE), particularly the Klebsiella pneumoniae carbapenemase-2 (KPC-2) producing Klebsiella pneumoniae, has been rapidly increasing worldwide and is becoming a serious public health threat. Since the epidemiology and characteristics of these KPC-2-producing K. pneumoniae vary according to the region and period under consideration, this study investigated the prevalence of carbapenemases and the epidemiological relationship of 78 carbapenem-resistant K. pneumoniae (CRKP) isolated from a tertiary hospital in Daejeon, from March 2017 to December 2020. The antimicrobial susceptibility tests were identified using the disk-diffusion method. PCR and DNA sequencing were used to determine the carbapenemase genes. In addition, molecular epidemiology was performed by multilocus sequence typing (MLST). Among the 78 CRKP isolates, 35 isolates (44.9%) were carbapenemase-producing K. pneumoniae (CPKP) and the major carbapenemase type was KPC-2 (30 isolates, 85.7%). The New Delhi metallo-enzyme-1 (NDM-1) and NDM-5 were identified in 4 isolates (11.4%) and 1 isolate (2.9%), respectively. Multilocus sequence typing (MLST) analysis showed 10 sequence types (STs) and the most prevalent ST was ST307 (51.4%, 18/35). All the ST307 isolates were KPC-2-producing K. pneumoniae and were multidrug-resistant (MDR). In addition, ST307 has gradually emerged during a four-year period. These findings indicate that continuous monitoring and proper infection control are needed to prevent the spread of KPC-2-producing K. pneumoniae ST307.

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