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배경: 2014년 1월부터 2015년 12월까지 중부지방 2곳의 종합병원에서 6개 계열 8종 항균제에 다제 내성을 나타내는 Enterobactercloacae 69주를 수집하였다. 방법: E-test법으로 최소억제농도(MIC)를 구하였고, TEM, SHV, CTX-M-1, CTX-M-2, CTX-M-8, CTX-M-9, NDM, OXA, IMI, IMP, VIM, FOX, EBC, CIT, ACC, DHA, MOX 등 17개 유전자를 PCR 증폭 후 검출하였다. 균주 간 역학적 연관성은 REP-PCR과 multilocus sequence typing (MLST)법으로 확인하였다. 결과: E. cloacae 69주는 ESBL과 AmpC를 생성하며 cefotaxime, ceftazidime, aztreonam에 다제 내성을 나타냈다. ESBL SHV (N=12, 17.4%)는 VI type의 ST56로, CTX-M (N=11, 15.9%)은 I, IV, VI, VII type의 ST53, ST114, ST133, ST550로, carbapenemase NDM (N=1, 1.5%)은 II type의 ST24, OXA (N=1, 1.5%)는 III type의 ST668로 확인되었다. AmpC DHA (N=2, 2.89%)는 type이 동정되지 않은 ST134, EBC (MIR/ACT) (N=18, 26.1%)는 V, I, III, IV, VII, VI type의 ST53, ST24, ST41, ST114, ST422, ST466, ST484, ST550로 확인되었다. CTX-M-1은 blaCTX-M-3, blaCTX-M-22, CTX-M-9은 blaCTX-M-9, blaCTX-M-125, DHA는 blaDHA-1, EBC (MIR/ACT)는 blaMIR-7, blaACT-15,17,18,25,27,28 아형을 생성하였다. 결론: 유전자 생성과 내성발생 균주 간 역학적 연관성은 없었다.
Background: From January 2014 to December 2015, 69 clones of Enterobacter cloacae showing multidrug resistance to six classes of antimicrobial agents were collected from two medical centers in Korea. Methods: Minimum inhibitory concentrations were determined using the E-test method, and 17 genes were detected using polymerase chain reaction (PCR). The epidemiological relatedness of the strains was identified using repetitive element sequence-based PCR and multilocus sequence typing. Results: The 69 E. cloacae clones produced extended spectrum β lactamase (ESBL) and AmpC and showed multidrug resistance to cefotaxime, ceftazidime, and aztreonam. We identified the following sequence types: ST56 of type VI for ESBL SHV (N=12, 17.4%), ST53, ST114, ST113, and ST550 of types I, IV, VI, and VII, respectively, for CTX-M (N=11, 15.9%), and ST668 of type III for the carbapenemase NDM gene (N=1, 1.5%). The AmpC DHA gene (N=2, 2.89%) was confirmed as ST134, although its type was not identified, whereas EBC (MIR/ACT, N=18, 26.1%) was identified as ST53, ST24, ST41, ST114, ST442, ST446, ST484, and ST550 of types V, I, III, IV, VII, and VI, respectively. The formed subclasses were blaCTX-M-3 and blaCTX-M-22 by CTX-M-1, blaCTX-M-9 and blaCTX-M-125 by CTX-M-9, blaDHA-1 by DHA, and blaMIR-7 and blaACT-15, 17, 18, 25, 27, 28 by EBC (MIR/ACT). Conclusions: There were no epidemiological relationships between the gene products and the occurrence of resistance among the strains.
