Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Molecular Epidemiology and Antimicrobial Resistance of Methicillin-resistant Staphylococcus aureus Isolated from Nasal Swab at Intensive Care Unit

중환자실 입원 환자의 비강 도말에서 메티실린 내성 황색포도알균의 분자역학, 항생제 내성 연구

  • Kwak, Om Sub (Department of Internal Medicine, College of Medicine, Konyang University) ;
  • Kwon, Mee Hye (Department of Internal Medicine, College of Medicine, Konyang University) ;
  • Jeong, Ji Hyun (Department of Internal Medicine, College of Medicine, Konyang University) ;
  • Kang, Mi-il (Department of Internal Medicine, College of Medicine, Konyang University) ;
  • Cheun, Ji Young (Department of Internal Medicine, College of Medicine, Konyang University) ;
  • Lee, Go Eun (Department of Internal Medicine, College of Medicine, Konyang University) ;
  • Kim, Young Keun (Department of Internal Medicine, College of Medicine, Konyang University) ;
  • Choi, Eu Gene (Department of Internal Medicine, College of Medicine, Konyang University) ;
  • Na, Moon Jun (Department of Internal Medicine, College of Medicine, Konyang University) ;
  • Kwon, Hee Uk (Department of Anesthesiology and Pain Medicine, College of Medicine, Konyang University) ;
  • Son, Ji Woong (Department of Internal Medicine, College of Medicine, Konyang University)
  • 곽엄섭 (건양대학교 의과대학 내과학교실) ;
  • 권미혜 (건양대학교 의과대학 내과학교실) ;
  • 정지현 (건양대학교 의과대학 내과학교실) ;
  • 강미일 (건양대학교 의과대학 내과학교실) ;
  • 천지영 (건양대학교 의과대학 내과학교실) ;
  • 이고은 (건양대학교 의과대학 내과학교실) ;
  • 김영근 (건양대학교 의과대학 내과학교실) ;
  • 최유진 (건양대학교 의과대학 내과학교실) ;
  • 나문준 (건양대학교 의과대학 내과학교실) ;
  • 권희욱 (건양대학교 의과대학 마취통증의학교실) ;
  • 손지웅 (건양대학교 의과대학 내과학교실)
  • Received : 2008.03.12
  • Accepted : 2008.06.18
  • Published : 2008.08.30
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Abstract

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is the most common organism associated with nosocomial infections. MRSA infections are becoming increasing important because they have emerged no only as healthcare-associated (HA) infections but also as community-associated (CA) ones. This study examined the moleculo-epidemiology of MRSA, which was isolated from nasal swabs in the intensive care unit (ICU) at Konyang University Hospital. MRSA are classified into HA-MRSA and CA-MRSA. Methods: From June to September 2006, 353 patients who were admitted to the ICU in Konyang University Hospital were enrolled in this study. Single nasal swabs were obtained for culture in the ICU on the 1st day. Pulsed-field gel electrophoresis and the antimicrobial resistant patterns were analyzed between HA- and CA-MRSA. An antimicrobial sensitivity test was also performed. Results: Forty two strains of MRSA were isolated from 353 patients (11.9%). Among the 42 isolates, HA-MRSA and CA-MRSA were found in 33 (78.6%), and 9 (21.4%), respectively. Eleven different PFGE types (type A to K) were identified. Types A (n=9) and B (n=7) were the most common for HA-MRSA, and types A (n=2) and B (n=2) were identified in CA-MRSA. The proportion of types A and B in CA-MRSA (44.4%) was similar to that in HA-MRSA (48.5%). The rates of resistance rates to erythromycin and ciprofloxacin were higher in HA-MRSA than in CA-MRSA. Conclusion: The rate of isolation of MRSA in an ICU setting was 11.9%. HA-MRSA was isolated more frequently than CA-MRSA. The rate of resistance of HA-MRSA to erythromycin and ciprofloxacin was higher than that of CA-MRSA. Despite the small number of subjects, the main isolates (type A and B) of CA-MRSA were similar to those of HA-MRSA.

연구배경: 메티실린 내성 황색포도알균은 의료기관 관련 감염 뿐 아니라 지역사회 감염에서도 나타나 이에 저자들은 한 대학병원 중환자실에 입원한 환자의 비강 도말 배양을 통해 MRSA의 의료기관 관련 감염 및 지역사회 감염의 빈도와 분자 역학 및 항생제 내성을 연구하였다. 방 법: 2006년 6월에서 9월까지 건양대학교 병원 중환자실 환자 353명을 대상으로 입실 첫날 비강 도말 배양을 시행하여 MRSA 획득 위험인자에 따라 HA-MRSA와 CA-MRSA로 나누어 Pulsed-Field Gel Electrophorosis (PFGE)로 분류하여 각각의 항생제 내성 검사를 시행하였다. 결 과: 353명 중 비강 도말 배양에서 동정된 MRSA는 42명(11.9%)이며, 동정된 MRSA 중 HA-MRSA는 33명(78.6%), CA-MRSA는 9명(21.4%)이다. PFGE에서 type A에서 type K까지 11형으로 구분하였고 HA-MRSA는 type A (n=9), B (n=7)가, CA-MRSA는 type A (n=2), B (n=2)가 주로 나타났다. 항생제 내성률은 erythromycin, ciprofloxacin에서 HA-MRSA가 CA-MRSA보다 높게 나타났다. 결 론: MRSA의 집락률은 11.9%이며 HA-MRSA의 균주가 CA-MRSA보다 많고, CA-MRSA는 9예로 적은 예지만 PFGE type에서 대부분의 type이 HA-MRSA에서 동정된 type과 같은 경향을 보여 지역사회전파를 시사한다.

Keywords

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