국내의 Acinetobacter baumannii와 Pseudomonas aeruginosa 임상분리주에 대한 Colistin과 Polymyxin B의 감수성 양상
Susceptibility of Clinical Isolates of Acinetobacter baumannii and Pseudomonas aeruginosa to Colistin and Polymyxin B in Korea
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배 경 : 다약제 내성 Acinetobacter baumannii와 Pseudomonas aeruginosa에 의한 감염의 증가로 인해 기존의 치료제를 대신할 수 있는 colistin이나 polymyxin B와 같은 대체 항균제들이 사용되고 있다. 이에 국내에서 분리된 A. baumannii와 P. aeruginosa에 대한 colistin과 polymyxin B의 감수성 현황을 알아보고자 하였다. 재료 및 방법 : 국내 5개 대학병원에서 분리된 균주 중 ceftazidime과 imipenem의 감수성에 따라 93주의 A. baumannii와 99주의 P. aeruginosa를 선택하였다. 액체배지 미량희석법으로 colistin과 polymyxin B의 감수성을 시험하였다. 결 과 : Ceftazidime과 imipenem이 감수성인 균주에서는 기타 β-lactam제, aminoglycoside제 및 ciprofloxacin에 대한 감수성율(각각 58-100%, 50-100%, 75-100%)이 높았으나, ceftazidime 또는 imipenem이 내성인 균주에서는 위의 항균제에 대한 감수성율이(각각 ≤31%, ≤47%, ≤18%)이 낮았다(P<0.05). Colistin과 polymyxin B에 대한 A. baumannii (MIC50/90, 1/2 g/mL)와 P. aeruginosa (MIC50/90, 1/1 g/mL)에의 항균 범위는 거의 유사하였고 두 약제 모두 매우 우수한 항균력을 보였다. A. baumannii에서는 1주(1.1%)가 colistin 내성(MIC, 4 g/ mL)이었으나 polymyxin B에는 감수성(MIC, 2 g/mL)이었으며 이외의 모든 A. baumannii와 P. aeruginosa는 colistin과 polymyxin B에 감수성(MIC, ≤2 g/mL)이었다. 결 론 : 국내에서 colistin과 polymyxin B에 둘 다 내성인 A. baumannii나 P. aeruginosa 감염은 없었다. 따라서 polymyxin제를 다약제 내성 A. baumannii나 P. aeruginosa 감염에 대한 대체 항균제로 유용하게 사용할 수 있을 것으로 생각된다.
Abstract
Background : The emergence of multidrug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa has become a major problem. The use of nontraditional agents such as colistin and polymyxin B have been tried. The purpose of this study was to evaluate the colistin and polymyxin B susceptibility of A. baumannii and P. aeruginosa isolates in Korea. Materials and Methods : According to susceptibility of ceftazidime and imipenem, selected 93 isolates of A. baumannii and 99 isolates of P. aeruginosa were collected from 5 university hospitals in Korea. Susceptibility to colistin and polymyxin B was tested using the reference broth microdilution method. Results : The rates of other β-lactams, aminoglycosides, and ciprofloxacin susceptibility were high (58-100%, 50-100%, and 75-100%, respectively) in ceftazidime- and imipenem-susceptible isolates but were low (≤31%, ≤47%, and ≤18%, respectively) in ceftazidime- or imipenem-resistant isolates (P<0.05). Colistin and polymyxin B displayed a nearly identical spectrum of activity, exhibiting excellent potency against A. baumannii (MIC50/90, 1/2 g/mL) and P. aeruginosa (MIC50/90, 1/1 g/mL). Only one of the A. baumannii isolates was resistant to colistin (MIC, 4 g/mL), but the isolate was susceptible to polymyxin B (MIC, 2 g/mL). Conclusion : In Korea, no A. baumannii and P. aeruginosa isolates were resistant to both colistin and polymyxin B. These data suggested that polymyxins may be alternative drugs for multidrug- resistant A. baumannii and P. aeruginosa isolates.
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