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1·2차 의료기관 임상 검체에서 분리된 Acinetobacter spp.의 항균제 내성과 Metallo-β-Lactamase 생성주 검출

Antimicrobial Resistance of Clinical Isolates of Acinetobacter spp. Collected from Non-Tertiary Hospitals and Detection of a Metallo-β-Lactamase-Producing Strain

김봉수|이영선|유재일|유용선|이점규
대한감염학회 (The Korean Society Of Infectious Diseases)|2004.10|Infection and Chemotherapy|제36권 제5호|pp. 271-278

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초록

목 적 : 지역사회 내 1·2차 의료기관의 임상 검체에서 분리된 Acinetobacter spp.의 항균제 내성 실태를 파악하고 imipenem 비감수성 균주의 표현형 및 유전형 특성을 조사하고자 하였다.재료 및 방법 : 임상 검체에서 분리된 Acinetobacter spp.의 균종 동정은 제한효소 Tsp5091를 이용한 recA- RFLP법을 이용하였고, 항균제 감수성은 NCCLS 지침에 따라 원산확산법과 희석법으로 결정하였다. Imipenem 비감수성 Acinetobacter spp.를 대상으로 Hodge 변형법과 EDTA-double disk synergy 법을 실시하여 metallo-β- lactamase 생성 여부를 감별한 후 PCR과 염기서열분석으로 blaVIM-2와 blaIMP-1 유전자 존재와 integron의 유전자 서열 구조를 확인하였다. 결 과 : 2002년과 2003년 사이 1·2차 의료기관의 임상 검체에서 분리된 Acinetobacter spp. 71주 중 A. baumannii가 60주였고, Acinetobacter genomic species 3, 13TU와 A. lowffii 가 각각 2, 4, 5주씩 분리되었다. 임상 분리 Acinetobacter spp.는 imipenem과 meropenem를 제외한 β-lactam계, aminoglycoside계 와 fluoroquinolone계 항균제에 높은 내성을 나타내었다. Imipenem MIC가 8 mg/L 인 Acinetobacter genomic species 13TU 1주는 blaVIM-2 유전자 뒤에 aacA7와 aadA1 유전자가 배열한 3 kb 크기의 class 1 integron을 보유하고 있었다.

Abstract

Background:The aim of this study was to investigate the antimicrobial resistance of clinical isolates of Acinetobacter spp. collected from non-tertiary hospitals and to characterize the phenotype and the genotype of imipenem-non-susceptible isolates. Materials and Methods:Clinical isolates of Acinetobacter spp. were identified using recA-restriction fragment length polymorphism (RFLP) analysis with Tsp5091. Susceptibility to antimicrobial agents was determined using disk diffusion test and agar dilution test according to the criteria of the National Committee for Clinical Laboratory Standards. PCR and sequence analyses were used to detect the blaIMP-1 and blaVIM-2 genes, and to determine the content and order of the resistance genes inserted in integron. Results:Of 71 Acinetobacter spp. isolates collected from non-tertiary hospitals during 2002 and 2003, 60 isolates were A. baumannii, and 2, 4, and 5 isolates were Acinetobacter genomic species 3, 13TU, and A. lwoffii, respectively. The resistance rate of Acinetobacter spp. isolates to β- lactams, aminoglycosides, and fluoroquinolones was high except for imipenem and meropenem. The presence of blaVIM-2 gene was found in one isolate, Acinetobacter genomic species 13TU, for which the MIC of imipenem was 8 mg/L; the blaVIM-2 gene of this strain was located on 3 kb class 1 integron with aacA7 and aadA1 genes. Conclusions:Among the tested agents, imipenem and meropenem retained greatest activity against Acinetobacter spp. isolates collected from non-tertiary hospitals. This is the first report of VIM-2-producing Acinetobacter genomic species 13TU strains with class 1 integron containing blaVIM-2 gene. 결 론: Imipenem과 meropenem은 1 ․2차 의료기관의 임상 분리 Acinetobacter spp.에 대해 가장 큰 활성을 가지고 있었고, 국내 처음으로 확인된 VIM-2 생성 Acinetobacter genomic species 13TU 1주는 blaVIM-2 유전자를 포함하는 class 1 integron을 보유하고 있었다.

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