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임상검체에서 분리된 그람음성막대균으로부터 카바페넴 내성유전자 검출

Detection of the Carbapenem Resistance Gene in Gram-negative Rod Bacteria Isolated from Clinical Specimens

Byoung Seon Yang
대한임상검사과학회 (Korean Society for Clinical Laboratory Science)|2022.09|대한임상검사과학회지 (Korean Journal of Clinical Laboratory Science)|제54권 제3호|pp. 179-191|DOI 10.15324/kjcls.2022.54.3.179

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Real-time PCRbla KPCbla NDMbla IMPbla VIMbla OXA-48-like
주제분류기타자연과학

초록

본 연구는 공중보건에 위협이 되고 있는 carbapenemase 유전자형 중 blaKPC, blaNDM, blaIMP, blaVIM, blaOXA-48-like 유전자의 표현형적 검사 및 분자진단으로 검출하고 관련 유전자 분포 양상에 대해 알아보았다. 표현형적 검사결과 MHT는 41균주모두에서 양성을 확인하고, CIT는 meropenem+PBA는 18균주 및 meropenem+EDTA에서 8균주의 양성을 확인하였다. PCR 결과 blaKPC 28균주, blaNDM 25균주, blaIMP 5균주, blaVIM 1균주, blaOXA-48-like 13균주에서 증폭 산물을 확인하였다. 또한 blaKPC+blaNDM 7균주, blaKPC+blaIMP 1균주, blaNDM+blaOXA-48-like 1균주, blaNDM+blaVIM 1균주, blaKPC+ blaNDM+blaIMP 4균주, blaKPC+blaNDM+blaOXA-48-like 4균주를 확인하였다. 실시간 중합효소 연쇄반응을 이용한 융해 곡선 분석결과는 PCR 결과와 100% 일치함을 확인하였다. 결론적으로 real-time PCR을 이용한 신속하고 특이성이 높은 CRE 조기진단을 통한 유전자 확인은 제한된 치료 옵션과 높은 사망률로 공중 보건 위협을 고조하는 CRE의 감시, 진단 및 치료를 개선할 수 있으며 전염을 방지하기 위한 효과적인 항균 치료 및 시기적절한 감염 통제가 가능할 것으로 사료된다.

Abstract

Carbapenem-resistant Enterobacteriaceae (CRE) poses an increasing public health threat and has limited treatment options with high associated mortality. Genotypes of carbapenemase that threaten public health (blaKPC, blaNDM, blaIMP, and blaVIM) and blaOXA-48-like genes were detected by phenotypic and molecular diagnosis, and related gene distribution patterns were investigated. Phenotypic testing using the modified Hodge test confirmed positivity in all 41 strains examined, and carbapenemase inhibitory testing using meropenem+phenyl boronic acid or meropenem+EDTA confirmed positivity in 18 and 8 strains, respectively. Polymerase chain reaction revealed the presence of amplification products in 28 strains of blaKPC, 25 strains of blaNDM, 5 strains of blaIMP, 1 strain of blaVIM, and 13 blaOXA-48-like strains. In addition, 7 strains of blaKPC+blaNDM, 1 strain of blaKPC+blaIMP, 1 strain of blaNDM+blaOXA-48-like, 1 strain of blaNDM+blaVIM, 4 strains of blaKPC+blaNDM+blaIMP, and 4 strains of blaKPC+blaNDM+blaOXA-48-like were identified. Melting curve analysis using real-time PCR was wholly consistent with PCR results. The study shows genetic identification of highly specific CRE by real-time PCR could be used to provide early diagnoses and infection control, improve surveillance, and prevent the transmission of CRE.

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경남지역 종합병원에서 분리된 그람음성막대균으로부터 blaKPC 및blaNDM 유전자 검출박지애, 양병선대한임상검사과학회 · 대한임상검사과학회지2021 · 제53권 제1호카바페넴분해효소 생성 장내세균 검출을 위한 Multiplex PCR의 개발 및 평가김나영, 김선주, 김시현, 배일권, 송새암, 신정환, Joseph Jeong대한임상미생물학회 · Annals of Clinical Microbiology2019 · 제22권 제1호카바페넴 내성 Enterobacterales에서carbapenemase의 신속 검출 및 형별 분류를 위한두 가지 상용화된 제품의 평가김미나, 성흥섭, 이승후, 정윤실, 허규화대한임상미생물학회 · Annals of Clinical Microbiology2021 · 제24권 제2호RAPIDEC CARBA NP 검사의 Carbapenemase 생성 장내세균의 진단 수행능력 평가어영, 송원근, 유길성, 황규열대한임상미생물학회 · Annals of Clinical Microbiology2016 · 제19권 제3호Evaluation of Xpert Carba-R Assay v.2 to Detect Carbapenemase Genes in Two Hospitals in Korea용동은, 최준용, Bomi Kim, Jung-Hyun Byun, Milee Kim, Yoon Soo Park, Young Ah Kim대한진단검사의학회 · Annals of Laboratory Medicine2020 · 제40권 제3호최근 4년간 한 대학병원에서 분리된 Carbapenemase 생성 Enterobacteriaceae의 분자 역학과 특성 분석김명숙, 김현수, 박은숙, 서영희, 성지연, 안선영, 용동은, 이경원, 종소리, 최준용, 하은진, 황연지대한임상미생물학회 · Annals of Clinical Microbiology2016 · 제19권 제2호

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