Korean Journal of Clinical Laboratory Science (대한임상검사과학회지)

Korean Society for Clinical Laboratory Science (대한임상검사과학회)
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The Characteristics of Imipenem-Resistant Bacteria Isolated from One Patient

한 환자에게서 분리된 Imipenem 내성세균들의 특성

  • Park, Chul (Department of Clinical Laboratory Science, Gwangyang Health Science University) ;
  • Lee, Hyeok-Jae (Department of Biomedical Laboratory Science, Gwangju Health Science University) ;
  • Seo, Min-Young (Department of Biomedical Laboratory Science, Gwangju Health Science University)
  • 박철 (광양보건대학교 임상병리과) ;
  • 이혁재 (광주보건대학교 임상병리과) ;
  • 서민영 (광주보건대학교 임상병리과)
  • Received : 2017.10.13
  • Accepted : 2017.11.08
  • Published : 2017.12.31
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Abstract

Four imipenem-resistant bacteria were isolated from the clinical specimens of a patient with pneumonia. To identify the isolates, we used the GN card of Vitek II system and performed a phylogenetic analysis based on 16S rRNA gene sequence. The isolates were identified as P. aeruginosa (2 strains), P. monteilii (1 strain), and P. putida (1 strain), and were tested for antibiotic resistance after determining the MIC of imipenem to be $${\geq_-}8{\mu}g/mL$$ using the AST-N225 card of Vitek II system. The imipenem-resistant genotypes were determined using PCR products amplified using specific ${\beta}-Lactamase$ gene primers. The MBL gene was identified in all four isolates. One strain of P. aeruginosa exhibited the VIM and SHV-1 type genes, while the other strain exhibited both VIM and OXA group II genes. According to the antimicrobial susceptibility test, the bacteria were more susceptible to amikacin than other antibiotics. DNA fingerprint analysis using ERIC-PCR to analyze the epidemiological relationship between strains estimated that both the P. aeruginosa isolates were similar, but exhibited different DNA band types. It is uncommon to find four strains of imipenem-resistant bacteria with different DNA band types in a single patient.

폐렴의 한(일개) 환자의 임상검체에서 연속적으로 분리된 Imipenem 내성세균 4균주를 분리하였다. 분리균을 동정하기 위해 Vitek II system의 GN card를 이용하였으며 16S rRNA유전자 염기서열을 기초로 계통학적 분석을 실시하였다. 분리균은 P. aeruginosa (2 strains), P. monteilii (1) 및 P. putida (1) 으로 동정되었다. 분리균들의 항생제에 대한 내성시험은 Vitek II system AST-N225 card를 이용해서 imipenem의 최소억제 농도가 모두 $${\geq_-}8{\mu}g/mL$$을 확인한 후 실험에 사용하였다. ${\beta}-Lactamase$ 유전자의 특이 시발체를 이용하여 증폭한 PCR 산물로 imipenem 내성 유전자형을 결정하였는데 분리된 4균주 모두에서 MBL 유전자를 확인하였으며 2균주의 P. aeruginosa는 MBL유전자중 VIM형과 SHV형 유전자를 그리고 또다른 균주는 VIM형과 OXA group II형 유전자를 동시에 보유하고 있었다. 항생제 감수성 결과에서는 amikacin이 다른 항생제보다 감수성을 보였을 뿐 대체적으로 내성율이 높았다. 균주들간의 역학적 연관성 분석을 위해 ERIC-PCR을 이용한 DNA 지문 분석결과, 분리된 2 균주의 P. aeruginosa는 유사한 균주일 것으로 추정하였으나 DNA band 유형의 상동성은 서로 다른 유형임을 알아 볼 수 있었다. 특이하게 한 환자에게서 imipenem 내성세균이 4균주가 검출 된 것은 이례적이며 동종의 DNA band 유형도 서로 상이하였다.

Keywords

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