16S rRNA 유전자 염기서열 분석에 의해 확인된 Acinetobacter spp. 가성요로감염 유행
Pseudooutbreak of Acinetobacter spp. Bacteriuria Confirmed by 16S rRNA Gene Sequence Analysis
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목 적 : 본 연구는 일개 대학병원의 한 병동에서 16S rRNA 유전자 염기서열 분석을 통해 확인된 Acinetobacter spp. 가성요로감염 집단 발생에 대한 조사이다. 재료 및 방법 : 일개 대학병원의 일반병동에서 2005년 9월 23일부터 26일까지 5명의 환자에서 Bordetella bronchiseptica 세균뇨가 동시에 분리되었다. 해당 환자들에 대한 입원 진료 기록을 확인하고, 이학적 검사를 시행하였고, 의료진 면담 등의 역학적 조사와 의심되는 전파원의 환경 감시배양을 시행하였다. 또한 다섯 균주들의 상동성 확인을 위해 pulsed field gel electrophoresis (PFGE)를 하였고, 정확한 균 동정을 위해 16S rRNA 유전자 염기서열 분석을 하였다. 결 과 : VITEK system에 의해 B. bronchiseptica로 보고된 다섯 균주들은 거의 유사한 항생제 감수성을 가지고 있었다. 유행조사에서 요로감염의 증상이나 균혈증을 보인 환자는 없었고, 환경 감시배양에서 공통의 전파원은 증명되지 않았다. 또한 PFGE와 16S rRNA 유전자 염기서열 분석에서 상동성을 가진 동일 Acinetobacter spp.로 확인되어 이에 의한 가성요로감염의 유행으로 결론지었다. 결 론 : 역학적 조사와 함께 PFGE와 16s rRNA 유전자 염기서열 분석과 같은 분자생물학적인 조사를 시행하는 것은 희귀한 균에 의한 병원감염 유행조사에 도움이 될 것이다.
Abstract
Background : Acinetobacter spp. is increasingly implicated in hospital-acquired infections. We experienced a pseudooutbreak of Bordetella bronchiseptica bacteriuria identified with biochemical tests, that was later identified as Acinetobacter spp. by using 16S rRNA gene sequence analysis. Materials and Methods: Five in-ward patients were found to have B. bronchiseptica bacteriuria without symptoms of urinary tract infection between September 23 and 26 of 2005. We conducted pulsed field gel electrophoresis (PFGE) of the bacteria and epidemiological investigation of this pseudooutbreak. In addition, 16S rRNA gene sequence analysis was performed for the verification of the strains. Results : All 5 isolates were identified as B. bronchiseptica with similar antibiogram by VITEK system. There was no evidence of any symptom or sign of urinary tract infection. The source of this pseudooutbreak was not detected even after performing environmental culture and interviews with healthcare workers. We could not get the appropriate results from the first PFGE with XbaI restriction enzyme. B. bronchiseptica is an unusual organism in human so we conducted 16S rRNA gene sequence analysis for verification. The analysis of 16S rRNA gene sequence with 5 isolates demonstrated 99-100% similarity to a sequence of Acinetobacter spp. (AU1523). According to the results of 16S rRNA gene sequence analysis, we performed the second PFGE with SmaI restriction enzyme, which showed indistinguishable pattern among the all 5 isolates. Conclusion : This investigation suggests that the combined method of 16s rRNA gene sequence analysis and PFGE would be helpful for investigation of outbreak caused by unusual organisms.
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