소아 요로감염의 원인 Escherichia coli 균의 계통 분류와 독성인자 분석
Phylogenetic Groups and Virulence Factors of Escherichia coli Causing Urinary Tract Infection in Children
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목적: 요로감염은 소아에서 흔한 세균 감염이며, Escherichia coli 가 주요 원인균이다. 본 연구는 우리나라에서 소아 요로감염을 일으키는 E. coli 의 계통 분류와 독성인자를 분석하고자 하였다방법: 2010년 10월부터 2013년 4월까지 요로감염으로 입원한 33명의 소아 환자로부터 검출된 E. coli 균주를 대상으로 하였다. 중합효소연쇄반응을 통해 E. coli 의 계통 분류 및 5가지 독성인자(fimH , sfa , papA , hylA , and cnf1 )를 조사하였다. E. coli 의 분자유전학적 특징을 환자의 임상적 진단과 동반된방광요관 역류에 따라 분석하였다. 결과: 대부분의 요로병원성 E. coli 는 계통 분류에서 B2군(84.8%)에 속했으며, 나머지는 모두 D군(15.2%)에 해당되었다. 독성인자는 fimH (100%), sfa (100%), hylA (63.6%), cnfI (63.6%), 그리고 papA (36.4%)의 분포를 보였다. 임상 진단에 따른 계통 분류에서 급성 신우신염의 경우 B2군이92.3%, D군이 7.7%를 나타냈으며, 방광염에서는 B2군에서 57.1%, D2군은 42.9%였다. 독성인자는양 군에서 비슷하게 분포하였다. 급성 신우신염에서 방광요관 역류의 유무에 따른 계통 분류의 분포에는 차이가 없었으나, 독성인자의 경우 papA 유전자가 방광요관 역류가 동반되지 않은 군에서보다 방광요관 역류 군에서 적게 나타났다(43.8% vs. 20.0%, P =0.399). 결론: 본 연구는 국내 소아 요로감염의 원인 E. coli 균주의 분자유전학적 역학 자료를 제시하였으며, 이 결과는 향후 소아 요로감염의 발생 기전을 이해하는 데 기초가 될 것으로 생각된다.
Abstract
Purpose: Urinary tract infection (UTI) is a common bacterial infection in children and Escherichia coli is a predominant pathogen. The purpose of this study is to evaluate phylogenetic groups and virulence factors of E. coli causing UTI in children in Korea. Methods: From October 2010 to April 2013, urinary E. coli strains were isolated from the 33 pediatric patients of UTI. Multiplex polymerase chain reactions were performed to evaluate the phylogenetic groups and 5 virulence factor genes (fimH, sfa, papA, hylA, and cnf1) of E. coli . Distribution of molecular characteristics of E. coli was analyzed by clinical diagnosis and accompanying vesicoureteral reflux (VUR). Results: Most (84.8%) uropathogenic E. coli were belonged to phylogenetics group B2 and the others (15.2%) were belonged to group D. The virulence factors were distributed as: fimH (100%), sfa (100%), hylA (63.6%), cnfI (63.6%), and papA (36.4%). According to clinical diagnosis, phylogenetic distribution of E. coli strain was 92.3% of B2 and 7.7% of D in acute pyelonephritis and 57.1% of B2 and 42.9% of D in cystitis. Distribution of virulence factors was similar in both groups. In patients with acute pyelonephritis, phylogenetic distribution was similar in VUR and non-VUR group, but proportion of papA genes were lower in VUR group than that of non-VUR group (43.8% vs. 20.0%, P =0.399). Conclusions: This study provides current epidemiologic molecular data of E. coli causing pediatric UTI in Korea and will be a fundamental for understanding the pathogenesis of pediatric UTI.
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