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Imipenem 내성 Pseudomonas aeruginosa의 분리 현황과 내성 획득 기전

Prevalence of Imipenem-Resistant Pseudomonas aeruginosa Isolates and Mechanisms of Resistance

정연욱|이보영|정석훈|배일권|윤외숙|권수봉|정태전
대한임상미생물학회 (Korean Society of Clinical Microbiology)|2005.04|Annals of Clinical Microbiology|제8권 제1호|pp. 26-33

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배경：Carbapenem에 내성인 Pseudomonas aeruginosa의 출현 및 확산은 이 세균에 의한 감염증 치료의 어려움을 가중시킬 수 있으므로 임상적으로 중대한 문제이다. 본 연구에서는 부산의 한 대학병원에서 분리되는 P. aeruginosa를 대상으로 carbapenem에 대한 내성 현황을 조사하고 이들 내성세균이 생성하는 carbapenemase의 유전형을 규명함으로써 이 세균의 치료지침과 내성세균의 확산 방지책을 마련하는데 필요한 기초자료를 제공하고자 하였다. 방법：2004년 6월에서 9월에 고신대학교 복음병원 환자의 임상검체에서 분리된 P. aeruginosa를 대상으로 하였다. 항균제 감수성은 디스크 확산법, carbapenemase 생성균주 선별은 Hodge 변법, metallo-β-lactamase 생성균주 선별은 EDTA-disk synergy법으로 시험하였다. 최소억제농도는 한천희석법으로, β-lactamase의 pI는 isoelectric focusing으로 측정하였다. Carbapenemase의 유전형은 PCR 증폭산물의 염기서열을 분석하여 확인하였다. 결과：시험기간 중 총 77주의 P. aeruginosa가 분리되었다. Hodge 변법과 EDTA-disk synergy법에 각각 22주(55.0%)와 15주(37.5%)가 양성반응을 보였으며, 12주는 blaIMP-1, 15주는 blaOXA-23 유전자를 지니고 있었다. OXA-23 생성 P. aeruginosa에 대한 imipenem 및 meropenem의 MIC 범위는 각각 8-16 ㎍/mL 및 2-32 ㎍/mL였고, IMP-1 생성 균주에 대한 MIC는 각각 2-256 ㎍/mL 이상 및 2-128 ㎍/mL였다. 결론：부산의 한 대학병원에서 분리되는 P. aeruginosa는 OXA-23 혹은 IMP-1의 생성에 의해서 imipenem에 대한 내성을 흔히 획득함을 확인할 수 있었다. 이들 내성세균의 확산과 새로운 내성기전의 출현을 감시하기 위한 주기적인 조사가 필요한 것으로 생각한다.

Abstract

Background: Spread of imipenem-resistant Pseudomonas aeruginosa isolates is an important clinical threat. The aim of this study is to survey the prevalence of carbapenem-resistant P. aeruginosaisolates in a university hospital, Busan, Korea, and to determine the mechanisms of the resistance. Methods: P. aeruginosa isolates from the patients in Kosin University Gospel Hospital were collected during the period of June through September, 2004. Antimicrobial susceptibilities were tested by the disk diffusion method, and production of carbapenemase and metallo-β-lactamase was determined by the modified Hodge and EDTA-disk synergy tests, respectively. MICs were determined by the agar dilution method, and pIs of β-lactamases were determined by the isoelectric focusing. Genotypes of carbapenemases were determined by direct sequencing of amplified products. Results: A total of 77 clinical isolates of P. aeruginosa were collected. Twenty-two (55.0%) and 15 (37.5%) isolates showed positive results in the modified Hodge and EDTA-disk synergy tests, respectively. Searches for blaOXA-23 and blaIMP-1 genes showed positive results in 15 and 12 isolates, respectively. MIC ranges of imipenem and meropenem to OXA-23-producing isolates were 8-16 ㎍/mL and 2-32 ㎍/mL, respectively, and those to IMP-1-producing isolates were 2-≥256 ㎍/mL and 2-128 ㎍/mL, respectively. Conclusion: Production of OXA-23 or IMP-1 is the most prevalent mechanism of imipenemresistance in P. aeruginosa isolates in a university hospital, Busan, Korea. Periodical surveys are necessary to monitor the spreading of imipenem-resistant isolates and emerging new mechanisms of imipenem-resistance.

참고문헌 (36)

  1. "Pseudomonas and miscellaneous gram-negative bac", pp.2203~26 (2004), Mosby
  2. "Diffusion of β-lactam antibiotics through liposome membranes reconstituted from purified porins of the outer membrane of Pseudomonas aeruginosa", 34, pp.685~90 (1990)
  3. "Interplay of impermeability and chromosomal β-lactamase activity in imipenem-resistant Pseudomonas aeruginosa", 36, pp.2046~8 (1992)
  4. "Antibiotic susceptibility profiles of 941 gram-negative bacteria isolated from septicemic patients throughout Canada", 15, pp.615~28 (1992)
  5. "Ambler class A extended-spectrum β-lactamases in Pseudomonas aeruginosa:novel developments and clinical impact", 47, pp.2385~92 (2003)
  6. "More extended-spectrum β-lactamases", 35, pp.1697~704 (1991)
  7. "GES-2,a class A β-lactamase from Pseudomonas aeruginosa with increased hydrolysis of imipenem", 45, pp.2598~603 (2001)
  8. "Nosocomial spread of ceftazidime-resistant Klebsiella pneumoniae strains producing a novel class A β-lactamase,GES-3,in a neonatal intensive care unit in Japan", 48, pp.1960~7 (2004)
  9. "Molecular characterization of a cephamycin-hydrolyzing and inhibitor-resistant class A β- lactamase,GES-4,possessing a single G170S substitution in the Ω-loop", 48, pp.2905~10 (2004)
  10. "Characterization of the metallo-β-lactamase determinant of Acinetobacter baumannii AC-54", 97 reveals the existence of blaIMP allelic variants carried by gene cassettes of different phylogeny, 2000, pp.44, 1229~35
  11. "a novel metallo-β-lactamase from nosocomial Acinetobacter spp collected in Hong Kong between 1994 and 1998", pp.710~4 4
  12. "Characterization of VIM-2,a carbapenem-hydrolyzing metallo-β-lactamase and its plasmid- and integron-borne gene from a Pseudomonas aeruginosa clinical isolate in France", 44, pp.891~7 (2000)
  13. "Metallo-β-lactamases in clinical Pseudomonas isolates in Taiwan and identification of VIM-3,a novel variant of the VIM-2 enzyme", 45, pp.2224~8 (2001)
  14. "Transferable imipenem resistance in Pseudomonas aeruginosa", 35, pp.147~51 (1991)
  15. "Cloning and characterization of blaVIM,a new integron-borne metallo-β-lactamase gene from a Pseudomonas aeruginosa clinical isolate", 43, pp.1584~90 (1999)
  16. "blaVIM-2 cassette-containing novel integrons in metallo-β-lactamase-producing Pseudomonas aeruginosa and Pseudomonas putida isolates disseminated in a Korean hospital", 46, pp.1053~8 (2002)
  17. "A new integron carrying VIM-2 metallo-β-lactamase gene cassette in a Serratia marcescens isolate", 42, pp.217~9 (2002)
  18. "Molecular characterization of metallo-β-lactamase-producing Acinetobacter baumannii and Acinetobacter genomospecies 3 from Korea:identification of two new integrons carrying the blaVIM-2 gene cassettes", 49, pp.837~40 (2002)
  19. "Characterization of a new integron containing VIM-2,a metallo-β-lactamase gene cassette,in a clinical isolate of Enterobacter cloacae", 51, pp.397~400 (2003)
  20. "Evaluation of the Hodge test and the imipenem-EDTA double-disk synergy test for differentiating metallo-β-lactamase-producing isolates of Pseudomonas spp", 41, pp.4623~9 (2003)
  21. "Sequence analysis of ARI-1,a novel OXA β-lactamase,responsible for imipenem resistance in Acinetobacter baumannii 6B92", 44, pp.196~9 (2000)
  22. "OXA-24,a novel class D β-lactamase with carbapenemase activity in an Acinetobacter baumannii clinical strain", 44, pp.1556~61 (2000)
  23. "Genetic and functional analysis of the chromosome-encoded carbapenem-hydrolyzing oxacillinase OXA-40 of Acinetobacter baumannii", 47, pp.268~73 (2003)
  24. "Prevalence of OXA-23 extended-spectrum β-lactamase-producing clinical isolates of Acinetobacter baumannii in a university hospital,Busan,Korea", 7, pp.139~47 (2004)
  25. "Schreckenberger PC and von Graevenitz A Manual of Clinical Microbiology American Society for Microbiology", te(ver fc), pp.539~60 (1999)
  26. "National Committee for Clinical Laboratory Standards Performance standards for antimicrobial disk susceptibility testing National Committee for Clinical Laboratory Standards" (2001)
  27. "Modified Hodge and EDTA-disk synergy tests to screen metallo-β-lactamase-producing strains of Pseudomonas and Acinetobacter species", 7, pp.88~91 (2001)
  28. "National Committee for Clinical Laboratory Standards Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically-5th edition National Committee for Clinical Laboratory Standards" (2000)
  29. "The use of analytical isoelectric focusing for detection and identification of β-lactamases", 88, pp.169~78 (1975)
  30. "Genotypes of metallo-β-lactamase produced by imipenem-resistant Acinetobacter spp", 34, pp.360~6 (2002)
  31. "DNA sequencing with chain-terminating inhibitors", 74, pp.5463~7 (1977)
  32. "OXA-24,a novel class D β-lactamase with carbapenemase activity in an Acinetobacter baumannii clinical strain", 44, pp.1556~61 (2000)
  33. "Antimicrobial resistance of clinically important bacteria isolated from 12 hospitals in Korea", 7, pp.171~7 (2004)
  34. "Plasmid-mediated dissemination of the metallo-β-lactamase gene blaIMP among clinically isolated strains of Serratia marcescens", 39, pp.824~9 (1995)
  35. "Metallo-β-lactamase-producing gram-negative bacilli in Korean nationwide surveillance of antimicrobial resistance group hospitals in 2003:continued prevalence of VIM-producing Pseudomonas spp", 50, pp.51~8
  36. "Integron and gene cassettes:a genetic construction kit for bacteria", 43, pp.1~4 (1999)

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