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대전지역의 입원환자에서 분리된 Carbapenem 내성 Pseudomonas aeruginosa의 분자역학조사(2008년에서 2014년까지)

Molecular Analysis of Carbapenem-Resistant Pseudomonas aeruginosa Isolated from Patients Hospitalized in Daejeon between 2008 and 2014 Years

조혜현
대한임상검사과학회 (Korean Society for Clinical Laboratory Science)|2018.12|대한임상검사과학회지 (Korean Journal of Clinical Laboratory Science)|제50권 제4호|pp. 406-413|DOI 10.15324/kjcls.2018.50.4.406

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참고문헌

키워드

Multidrug-resistantVIM-2CRPAIMP-6ST235
주제분류기타자연과학

초록

최근 P. aeruginosa의 carbapenem에 대한 내성은 전 세계적으로 증가하고 있는 실정이다. 특히 metallo--lactamases (MBLs)는 carbapenem의 고도 내성에 관여하고 있는 것으로보고되고 있다. 한편, Sequence type 235 (ST235)는 다제내성클론으로써 국제적으로 보고되고 있으며, IMP-6와 VIM-2 유전자의 확산에도 관여하는 것으로 알려져 있다. 본 연구에서는2008년 3월부터 2014년 6월까지, 대전지역의 3차 병원에서 분리된 carbapenem 내성 P. aeruginosa에서 MBL 유전자를 분석하고 이에 대한 역학관계를 조사하고자 하였다. 항균제 감수성 양상은 디스크 확산법으로 확인하였고, MBL 유전자의 분석을 위해 PCR과 염기서열분석을 수행하였다. 더불어, 역학 관계를 조사하기 위해 multilocus sequence typing (MLST)를 실시하였다. 110 균주의 carbapenem 내성 P. aeruginosa 중, 32균주(29.1%)가 MBL를 생성하였고, IMP-6 (29균주, 90.6%)가 주요하게 확인되었다. VIM-2는 3균주(9.4%)에서 확인되었으며, 모두 ST357로 확인되었다. IMP-6를 생성하는 P. aeruginosa 는 모두 다제내성을 보였고, ST235로 확인되었다. ST235 (55 균주, 50.0%)는 가장 높은 비율로 확인된 클론이며 7년 동안 지속적으로 확인되었다. 이러한 다제내성 ST235의 확산을 방지하기 위해, carbapenem의 과도한 사용을 제한하고, 지속적으로 모니터링하는 전략이 개발되어야 할 것으로 사료된다.

Abstract

The emergence of carbapenem resistance among Pseudomonas aeruginosa has become an increasing problem worldwide. In particular, metallo-β-lactamases (MBLs) are responsible for the high-level resistance to carbapenem. Sequence type 235 (ST235) has been found internationally in a multidrug-resistant clone and is involved in the dissemination of genes encoding IMP-6 and VIM-2. This study examined the prevalence of MBLs and the epidemiological relationship in carbapenem-resistant P. aeruginosa (CRPA) isolates obtained from a tertiary hospital in Daejeon, Korea, between March 2008 and June 2014. The antimicrobial susceptibilities were determined using the disk-diffusion method and PCR and DNA sequencing were used to identify the MBL genes. In addition, an epidemiological relationship was investigated by multilocus sequence typing (MLST). Among the 110 CRPA isolates, 32 isolates (29.1%) were MBL-producers; the major type was IMP-6 (29 isolates, 90.6%). VIM-2 was identified in 3 isolates (9.4%) of ST357. IMP-6-producing isolates were multidrug-resistant (MDR) and belonged to ST235. ST235 (55 isolates, 50.0%) was the clone most frequently detected and has gradually emerged during a seven-year period. To prevent the spread of MDR ST235 P. aeruginosa isolates, the current widespread use of carbapenems needs to be curtailed, and novel continuous monitoring strategies should be developed as soon as possible.

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