Vancomycin 의존성 장구균의 미생물학적 특성과 역학적 특성
Microbiological and Epidemiological Characteristics of Vancomycin-dependent Enterococci
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배경 : Vancomycin-dependent enterococci (VDE)는 vancomycin- resistant enterococci (VRE)와 유사한 임상상을 보 이지만 검출하기 더 어렵다. 본 연구에서는 VDE의 미생물학적 특성과 역학적 특성을 살펴보았다. 방법 : 2007년 4월부터 2008년 3월까지 VDE가 분리된 환자 를 대상으로 하였다. E test (AB Biodisk, Sweden)법으로 vancomycin과 teicoplanin에 대한 최소억제농도와 의존성을 정량 적으로 측정하였고, 의존성 환원검사와 pulsed field gel electrophoresis (PFGE)를 시행하였다. 전자의무기록을 통해 환자 의 임상 소견을 확인하였다. 결과 : 연구 기간 동안 VRE가 분리된 환자 272명 중 6명(2.2 %)에서 VDE가 검출되었다. 모두 VDE가 분리되기 전에 VRE에 의한 감염이 있거나 집락화되어 있었고 13-107일간 vancomycin 치료를 받았다. VDE는 흉수 1검체와 소변 4검체, 대변 1검 체에서 분리되었고 모두 vanA형이었다. Vancomycin 최소억 제농도는 모두 256 μg/mL 이상이었고 2주는 teicoplanin에 중등도 감수성이었다. 2주의 VDE에서 vancomycin 의존성은 0.064, 0.5 μg/mL로 측정되고 각각 5번, 7번의 계대배양 후 내성으로 전환되었다. 다른 4주는 한 번의 계대배양 후 vancomycin 의존성이 환원되었다. VDE 6주는 모두 서로 다른 PFGE 양상을 보였으며, 4명의 환자에서 이전에 분리된 VRE와 VDE 쌍 중 3쌍의 VRE와 VDE 쌍은 각각 동일한 클론이었다. 결론 : VDE의 발생빈도는 드물지 않았고, VRE가 분리되는 환자에서 장기간 vancomycin에 노출되었을 때 독립적으로 발 생하였다. Vancomycin 의존성은 수 차례의 계대배양 후 내성 으로 환원되었다.
Abstract
Background : Vancomycin-dependent enterococci (VDE) are clinically equivalent to vancomycinresistant enterococci (VRE), but more difficult to detect. This study was purposed to characterize VDE microbiologically and epidemiologically. Methods : The patients from whom VDE were detected from April 2007 to March 2008 were investigated. For available isolates, minimal inhibitory concentrations (MICs) of and the levels of dependence on vancomycin and teicoplanin were measured by E test (AB Biodisk, Sweden), and a test for reversion of VDE to non-dependent VRE (NDVRE) and pulsed field gel electrophoresis (PFGE) were performed. Patients’ demographic and clinical findings were reviewed via electronic medical records. Results : VDE were recovered from 6 (2.2%) of 272 patients carrying VRE during this study period. All patients were already colonized or infected by VRE and treated with vancomycin for 13 to 107 days. VDE were isolated from pleural fluid (one), urine (four), and stool (one). All isolates carried vanA with vancomycin MICs of >256 μg/mL, but two of them had intermediate susceptibilities to teicoplanin. Because 4 VDE isolates were reverted to NDVRE with single passage, vancomycin dependence was measurable for only two isolates as equal and above 0.064 and 0.5 μg/mL respectively, and was reverted after 5 and 7 passages, respectively. Six VDE isolates showed no related clones in PFGE analysis, and 3 of 4 available pairs of initial VRE isolates and subsequent VDE isolates were identical clones. Conclusions : VDE were not rare and seemed to emerge independently from VRE with a prolonged use of vancomycin. Vancomycin-dependence was reverted within several passages.
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