중환자실의 임상검체로부터 분리된 Methicillin 내성 Staphylococcus aureus의 독소유전자형과 항생제내성의 상관관계
The Correlation between Toxin Genotype and Antibiotic Resistance in Methicillin Resistant Staphylococcus aureus Isolated from Clinical Specimen of Intensive Care Unit
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본 연구는 methicillin-resistant Staphylococcus aureus (MRSA)로부터, 독소 유전자형과 항생제 내성의 상관 관계를 결정하는 것을 목표로 하였다. 2014년 1월∼12월까지 전남 순천의 한병원 중환자실의 임상검체 2,664건에서 얻어진 MRSA 52균주를분리하였다. 유전자들이 암호화하고 있는 mecA, 장독소(staphylococcal enterotoxins; sea, seb, sec, seg, seh, sei, sej), 독성 쇼크 증상독소-1 (toxic shock syndrome toxin-1; tst-1), 표피박탈성독소(exfoliative toxin; eta, etb), 백혈구 용해 독소(Panton- Valentine leukocidin; pvl)를 특이적 프라이머를 이용한multiplex PCR로 증폭 검출 하였다. 독소 유전자 seg와 sei 유전자가 각각 40균주(76.9%)로 가장 많은 보유율을 나타냈으며 다음으로 tst 34균주(65.4%) 순으로 검출 되었으며 eta, etb, sea, sed, see, seh, sej와 pvl 유전자들은 검출 되지 않았다. 2개 이상의 독소유전자를 동시에 보유한 조합의 MRSA는 40균주(76.9%) 였는데 5 개 유전자(seb, sec, seg, sei, tst)를 동시 보유한 조합이 28균주(53.8%)로 가장 많은 분포를 보였으며 다음으로 seg, sei 유전자 동시 보유 조합으로 6균주(11.5%)에서 나타났다. 유전자들 간의 동시 보유율은 72.5∼100%로서 특정한 독소 유전자 seb, sec, seg, sei와 tst 유전자간의 상관성이 높게 나타났다. 특정 다수의 독소유전자(seb, sec, seg, sei, tst)를 동시에 보유한 균주들이 개별적 독소유전자를 보유한 균주(seb, sec, tst)와의 항생제 내성의 상관성은ciprofloxacin, clindamycin, erythromycin 항생제에 100% 내성을 보임으로서 공통적으로 포함된 seb, sec, tst 유전자와 이 항생제의 내성과는 밀접한 연관이 있음을 알았다.
Abstract
This study is aimed to determine the correlation between the toxin gene types and antibiotic resistance from MRSA (methicillin-resistant Staphylococcus aureus). Fifty-two strains of MRSA, between January 2014, and December 2014, were isolated from clinical specimens obtained from 2,664 cases in the intensive care unit of a hospital in Suncheon, Jeonnam, Korea. Genes encoding mecA, enterotoxin (SE), toxic shock syndrome toxin-1 (TSST-1), exfoliative toxin (ET), and Panton-Valentine leukocidin (PVL) were detected by multiplex PCR-mediated amplification using specific primers. Toxin genes (seg and sei) were present in 40 strains (76.9%), followed by tst in 34 strains (65.4%). Other genes (eta, etb, sea, sed, see, seh, sej, and pvl) were not detected. Forty strains (76.9%) of MRSA had 2 or more toxin genes simultaneously; 5 coexistent toxin-genes (seb, sec, seg, sei, tst) were the most common in 28 strains (53.8%), and 6 strains (11.5%) had seg and sei genes. The coexistence of genes were 72.5∼100%, showing a high correlation among genes (seb, sec, seg, sei and tst). As strains (seb, sec, tst) that had particular toxin genes (seb, sec, seg, sei, tst) in multiple showed 100% resistance to ciprofloxacin, clindamycin, erythromycin, we were able to find that seb, sec, and tst genes have a close relationship to the aforementioned antibiotics. It showed a higher resistance to ciprofloxacin, clindamycin, erythromycin, and tetracycline compared with strains that had toxin genes independent from multiple toxin genes.
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