국내 한 대학병원의 2001-2010년 장염 세균 분리 추세와 항균제 감수성 양상
Trends in Isolation and Antimicrobial Susceptibility of Enteropathogenic Bacteria in 2001-2010 at a Korean Tertiary Care Hospital
0
조회
0
다운로드
10
인용
0
참고문헌
키워드
초록
배경: 우리나라의 환경 위생이 개선됨에 따라 장염 세균의 분리 경향도 달라지고 있다. 본 연구에서는 최근 10년간 장염세균의 분리 양상과 항균제 내성률을 분석하였다. 방법: 2001-2010년에 의뢰된 환자의 변 배양 검사 결과를 분석하였다. 검사 대상은 Salmonella spp., Shigella spp., Plesiomonas shigelloides, Yersinia spp., Vibrio spp.와 Campylobacter spp.였다. 분리된 장염 세균 중 nontyphoidal Salmonella (NTS) 와 Campylobacter에 대하여 디스크 확산법으로 항균제 감수성을 시험하였다. 결과: 1969-1978년과 비교하여 지난 10년간 의뢰된 검체 수는 13,412건에서 60,714건으로 현저히 증가한 반면, 양성 검체비율은 12.9% (1,732 검체)에서 1.1% (648 검체)로 현저히 감소하였다. Salmonella 중 Salmonella Typhi의 비율이 1969-1978 년에는 97.2%였으나, 2001-2010년에는 0.8%로 줄었다. 반면 NTS의 비율은 2.8%에서 99.2%로 점차 증가하였다. 1969-1983년에는 Shigella가 전체 장염 세균의 50% 이상이었으나, 2001-2010년에는 집단발생을 제외하고 7주만 분리되었다. Campylobacter가 Salmonella 다음으로 많이 분리되었다. 2006-2010년 분리 NTS의 ampicillin과 cotrimoxazole 감수성률은 61%와 92%였고, 같은 기간에 분리된 Campylobacter의 ciprofloxacin에 대한 감수성률은 79.5%였다. 결론: 병원 내 감염관리를 위한 감시 배양이 활발해짐에 따라 의뢰된 검체 수는 증가한 반면, 환경 위생의 개선으로 장염세균의 분리 비율은 감소하였다. Salmonella Typhi와 Shigella의 분리 수는 현저히 감소한 반면, NTS와 Campylobacter의분리 비율이 증가하였으며 ciprofloxacin 내성 Campylobacter가 증가하여 이에 대한 감시가 필요하다.
Abstract
Background: Trends in the isolation of enteropathogenic bacteria may differ depending on environmental sanitation. The aims of this study were to determine trends in the isolation and antimicrobial resistance patterns of enteropathogenic bacteria over the last 10 years. Methods: We analyzed stool cultures of Salmonella spp., Shigella spp., Plesiomonas shigelloides, Yersinia spp., Vibrio spp., and Campylobacter spp. collected at Severance Hospital between 2001 and 2010. Antimicrobial susceptibility testing was performed using the disk diffusion method for nontyphoidal Salmonella (NTS) and Campylobacter. Results: The number of specimens for stool culture significantly increased from 13,412 during 1969-1978 to 60,714 over the past 10 years, whereas the ratio of positive specimens significantly decreased from 12.9% (1,732) to 1.1% (648). The proportion of Salmonella Typhi decreased from 97.2% in 1969-1978 to 0.8% in 2001-2010, whereas the proportion of NTS increased from 2.8% to 99.2%. The proportion of Shigella among all enteric pathogens was over 50% from 1969 to 1983, while only seven strains were isolated from 2001 to 2010, with the exception of one outbreak. Campylobacter is the second most prevalent organism. The rates of susceptibility to ampicillin and cotrimoxazole were 61% and 92%, respectively, for NTS isolated from 2006 to 2010. The ciprofloxacin susceptibility rate was 79.5% for Campylobacter between 2006 and 2010. Conclusion: The number of isolates of Salmonella Typhi and Shigella significantly decreased, while the proportion of NTS and Campylobacter increased. Continuous monitoring of ciprofloxacin-resistant Campylobacter isolates is necessary.
참고문헌 (31)
- "Diarrhoeal disease"[URL]
- Shin HB, "Isolation trend of enteropathogenic bacteria in 1969-1998", Korean J Clin Microbiol, 4, pp.87~95 (2001)
- Rohde H, "Open-source genomic analysis of Shiga-toxin-producing E", coli O104:H4, 365, pp.718~724 (2011)
- 대한감염학회, "소화기계 감염 진료지침 권고안", Infection and Chemotherapy, 42(6), pp.323~361 (2010), 대한감염학회
- "The prevalence and characteristics of bacteria causing acute diarrhea in Korea, 2008"[URL]
- Murry PR, "Manual of Clinical Microbiology. 9th ed", pp.935~937 (2007), American Society for Microbiology
- Clinical and Laboratory Standards Institute, "Performance standard for antimicrobial susceptibility testing; twentieth informational supplement; Approved guideline. Document M100-S20", Clinical and Laboratory Standards Institute, ~ (2010)
- Clinical and Laboratory Standards Institute, "Methods for antimicrobial dilution and disk susceptibility testing of infrequently isolated or fastidious bacteria; Approved guideline. Document M45-A", Clinical and Laboratory Standards Institute, ~ (2006)
- Thapar N, "Diarrhoea in children: an interface between developing and developed countries", Lancet, 363, pp.641~653 (2004)
- Kendall ME, "ravel-associated enteric infections diagnosed after return to the United States, Foodborne Diseases Active Surveillance Network (FoodNet), 2004-2009", Clin Infect Dis, 54(Suppl 5), pp.S480~S487 (2012)
- "CDC web sites on center for emerging and zoonotic infectious diseases"[URL]
- 진영희, "서울지역 소아에서 분리된 Nontyphoid Salmonella의 항생제 내성과 Integron의 특징", 미생물학회지, 46(4), pp.326~333 (2010), 한국미생물학회
- Seo S, "The serogroup and antimicrobial resistance of Salmonella spp. isolated from the clinical specimens during 6 years in a Tertiary University Hospital", Korean J Clin Microbiol, 7, pp.72~76 (2004)
- Li WC, "Ceftriaxone resistance of nontyphoidal Salmonella enterica isolates in Northern Taiwan attributable to production of CTX-M-14 and CMY-2 beta-lactamases", J Clin Microbiol, 43, pp.3237~3243 (2005)
- "Communicable Diseases Weekly Report, 2001.1:10"[URL]
- [URL]
- 김미나, "세균성 설사 원인균의 신속검출을 위한 다중 중합효소연쇄반응 검사의 대변검체에 대한 직접 적용", Annals of Clinical Microbiology, 13(4), pp.162~168 (2010), 대한임상미생물학회
- Kwon SR, "Estimated magnitude of an outbreak of Vibrio parahaemolyticus enteritis in inchon, Korea", Korean J Infect Dis, 32, pp.100~107 (2000)
- Murry PR, "Manual of Clinical Microbiology", pp.689~704 (2007), American Society for Microbiology
- Seung-Hak Cho, "Enteric Bacteria Isolated from Acute Diarrheal Patients in the Republic of Korea between the Year 2004 and 2006", The Journal of Microbiology, 46(3), pp.325~330 (2008), 한국미생물학회
- Rautelin HI, "Prospective study of the etiology of diarrhea in adult outpatients and inpatients", Scand J Gastroenterol, 24, pp.329~333 (1989)
- Lee K, "Diversity of TEM-52 extended-spectrum beta-lactamase-producing non-typhoidal Salmonella isolates in Korea", J Antimicrob Chemother, 52, pp.493~496 (2003)
- Yong D, "Nosocomial outbreak of pediatric gastroenteritis caused by CTXM- 14-type extended-spectrum beta-lactamase-producing strains of Salmonella enterica serovar London", J Clin Microbiol, 43, pp.3519~3521 (2005)
- Koirala J, "Multidrug-resistant Salmonella enterica", Lancet Infect Dis, 11, pp.808~809 (2011)
- Koirala KD, "Highly resistant Salmonella enterica serovar Typhi with a novel gyrA mutation raises questions about the long-term efficacy of older fluoroquinolones for treating typhoid fever", Antimicrob Agents Chemother, 56, pp.2761~2762 (2012)
- Tamang MD, "Prevalence and mechanisms of quinolone resistance among selected nontyphoid Salmonella isolated from food animals and humans in Korea", Foodborne Pathog Dis, 8, pp.1199~1206 (2011)
- Sam WI, "Increasing rates of ciprofloxacin resistant Campylobacter", J Clin Pathol, 52, pp.709~ (1999)
- Murphy GS Jr, "Ciprofloxacin- and azithromycin-resistant Campylobacter causing traveler's diarrhea in U.S. troops deployed to Thailand in 1994", Clin Infect Dis, 22, pp.868~869 (1996)
- Johnson JY, "4Risk factors for ciprofloxacin resistance in reported Campylobacter infections in southern Alberta", Epidemiol Infect, 136, pp.903~912 (2008)
- 김신무, "Cytolethal Distending Toxin Production, Genotypes and Atimicrobial Susceptibility of Campylobacter jejuni Isolates from Diarrhea Patients and Chickens", Journal of Bacteriology and Virology, 38(4), pp.207~219 (2008), 대한미생물학회
- Pollett S, "Campylobacter antimicrobial resistance in Peru: a ten-year observational study", BMC Infect Dis, 12, pp.193~ (2012)