충청지역의 임상검체에서 분리된 폐렴막대균에 CTX-M형 Extended-Spectrum β-lactamases 확산
Dissemination of CTX-M Type Extended-Spectrum β-Lactamases Among Klebsiella pneumoniae Clinical isolates in Chungcheong Province
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다양한 extended-spectrum β-lactamase (ESBL)를 생성하는 폐렴막대균의 출현 및 확산은 세균에 의한 감염증 치료에 어려움을 가중시키고 있다. 본 연구에서는 충청지역에서 분리된 폐렴막대균을 대상으로 ESBL 유전자를 검출하고 항균제 감수성 양상을 조사하였다. 또한 같은 클론에서 유래하였는지를 확인하기 위해 repetitive element sequence-based (REP)-PCR을 수행하였다. 충청지역에서 분리된 폐렴막대균 102균주 중 21균주가 CTX-M-14 및/또는 CTX-M-15를 생성하는 것으로 나타났으며 이 균주들은 3세대 cephalosporin 계열 항균제에 대해 70% 이상의 높은 내성율을 보였다. 본 연구에서 분리된 CTX-M형 ESBL생성 폐렴막대균은 다양한 클론으로부터 유래되었으며 그 중 일부는 지역사회에 확산되어 있음이 확인되었다. 이러한 폐렴막대균의 감염 및 확산을 방지하기 위해서는 감염관리의 강화가 필요하다. 아울러 좀 더 효과적인 내성세균의 관리를 위해서는 내성유전자의 생물학적 조사와 통계학적 분석을 통해 통합적으로 구축된 데이터베이스를 모니터링 할 필요가 있을 것으로 사료된다.
Abstract
The emergence and dissemination of extended-spectrum β-lactamse (ESBL) producing Klebsiella pneumoniae isolates make it more difficult to treatment of bacterial infections. In our study, we detected ESBL genes and investigated antimicrobial susceptibility of K. pneumoniae isolates in Chungcheong province. In addition, clonality among the isolates was analyzed by repetitive element sequence (REP)-PCR. Twenty-one of 102 K. pneumoniae isolates produced CTX-M-14 and/or CTX-M-15 and showed high level (over 70%) resistance to third cephalosporins. CTX-M type ESBL producing K. pneumoniae strains isolated in our study showed diverse clonality and some of the isolates have been disseminated in the community. Enhancing infection control will be needed to prevent dissemination of the K. pneumoniae isolates. In addition, for more effective control of resistant bacteria it is considered necessary to monitor the database constructed through convergence of biological investigation and statistical analysis of antimicrobial resistance genes.
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