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한국에서 분리된 카바페넴 분해효소 생성 장내세균의 분자적 특성 분석 및 항균 내성(2019-2021)

Molecular Characteristic Analysis and Antimicrobial Resistance of Carbapenem- Producing Enterobacteriaceae Isolates in the South Korea, 2019-2021

Lee Miyoung
한국미생물·생명공학회 (The Korean Society For Microbiology And Biotechnology)|2024.12|한국미생물·생명공학회지 (Microbiology and Biotechnology Letters)|제52권 제4호|pp. 479-486|DOI 10.48022/mbl.2410.10001

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Carbapenemase-producing EnterobacteriaceaeMulti drug-resistant (MDR)Tn4401Escherichia coli ST410Klebsiella pneumoniae ST307carbapenem-resistant Enterobacteriaceae
주제분류생물학

초록

카바페넴 분해효소생성 장내세균(Carbapenemase-producing Enterobacteriaceae, CPE)의 전 세계적 확산은 중대한 공중보건 문제를 일으키며, 이로 인해 병원성과 사망률이 증가하고 있다. 2019년 7월부터 2021년 7월까지 한국의 한 종합병원에서 다양한 임상 검체에서 분리된 44개의 CPE 균주로 항균제 감수성 시험, β-lactamase 유전자 검출을 위한중합효소 연쇄반응(PCR), DNA 염기서열 분석, Tn4401 Transposon 변이체 분석, 다좌위 서열 분석(MLST)과 접합실험을 실시했다. 분석 결과 모든 균주가 다제내성을 보였으며, 특히 colistin내성인 균주가 2균주(4.5%) 존재하였다. 카바페넴 분해효소 생성 유전자의 종류는 다양해져, KPC-2 생성 30균주(68.2%), NDM-5 생성 9균주(20.5%), 2종 이상의카바페넴 분해효소를 동시에 갖는 유형으로 KPC-2와 NDM5균주3균주(6.82%), NDM-5와 OXA-181균주 2균주 (4.55%)로확인되었다. 고위험 클론인 K. pneumoniae ST307 (56.3%) 과 E. coli ST410 (54.5%)이 확인되었으며, 플라스미드 매개내성 전이율은 77.3%로 나타났다. 또한, 높은 빈도의 트랜스포존 Tn4401 (84.8%)의 검출은 CPE의 빠른 확산 및 진화와관련이 있다. 이러한 결과는 한국에서 빠르게 확산되고 있는광범위 약제내성 고위험 클론의 문제를 해결하기 위해 엄격한 국가 차원의 관리 대책이 시급히 필요함을 강조한다

Abstract

We analyzed the molecular genetic characteristics of carbapenemase-producing Enterobacteriaceae (CPE) isolated from a South Korean hospital between July 2019 and July 2021. A total of 44 CPE strains were isolated from various clinical samples and tested for antimicrobial susceptibility, the presence of β-lactamase genes, Tn4401 transposon variants, multi locus sequence typing, and conjugation ability. All strains showed multidrug resistance, with two strains (4.5%) displaying colistin resistance. Diverse carbapenemase genes were identified in the strains, with 68.2% carrying the gene for KPC-2 and 20.5% carrying the gene for NDM5. Additionally, 6.82% of the strains carried genes encoding both KPC-2 and NDM-5, while 4.55% carried genes encoding both NDM-5 and OXA-181. High-pathogenicity clones of Klebsiella pneumoniae ST307 (56.3%) and Escherichia coli ST410 (54.5%) were also identified. The plasmid-mediated resistance transfer rate was high (77.3%). Additionally, 84.1% of examined strains contained the Tn4401 transposon, which facilitates the rapid spread and evolution of CPE. These findings underscore the urgent need for national control strategies to curb the spread of highly pathogenic drug-resistant clones. This study highlights the importance of controlling CPE to prevent further increase in bacteria-associated morbidity and mortality in South Korea.

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