Korean Journal of Clinical Laboratory Science (대한임상검사과학회지)

Korean Society for Clinical Laboratory Science (대한임상검사과학회)
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Clinical Laboratory Aspect of Carbapenem-Resistant Enterobacteriaceae

카바페넴내성장내세균속균종의 임상검사 측면

  • Park, Chang-Eun (Department of Biomedical Laboratory Science.Molecular Diagnostics Research Institute, Namseoul University)
  • 박창은 (남서울대학교 임상병리학과.분자진단연구소)
  • Received : 2020.02.08
  • Accepted : 2020.02.27
  • Published : 2020.03.31
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Abstract

The correct distinction of carbapenem-resistant Enterobacteriaceae (CRE) and ccarbapenemase producing Enterobacteriaceae (CPE) and the rapid detection of CPE are important for instituting the correct treatment and management of clinical infections. Screening protocols are mainly based on cultures of rectal swab specimens on selective media followed by phenotypic tests to confirm a carbapenem-hydrolyzing activity, the rapid carbapenem inactivation method, lateral flow immunoassay, the matrix-assisted laser desorption ionization-time-of-flight test and molecular methods. The CPE is accurate for detection, and is essential for the clinical treatment and prevention of infections. A variety of phenotypic methods and gene-based methods are available for the rapid detection of carbapenemases, and these are expected to be routinely used in clinical microbiology laboratories. Therefore, to control the spread of carbapenemase, many laboratories around the world will need to use reliable, fast, high efficiency, simple and low cost methods. Optimal effects in patient applications would require rapid testing of CRE to provide reproducible support for antimicrobial management interventions or the treatment by various types of clinicians. For the optimal test method, it is necessary to combine complementary test methods to discriminate between various resistant bacterial species and to discover the genetic diversity of various types of carbapenemase for arriving at the best infection control strategy.

카바페넴내성장내세균속균종(carbapenem-resistant Enterobacteriaceae, CRE)과 카바페넴분해효소 생성 장내세균과(carbapenemase-producing Enterobacteriaceae, CPE)의 정확한 구분과 CPE의 빠른 탐지는 임상 감염의 치료 및 관리에 중요하다. 선별방법은 주로 선택적 배지에서의 직장 면봉 표본 배양 후 카바페넴분해 효소의 활성도, 신속한 카바페넴의 불활성화 방법, 측방유동면역분석(lateral flow immunoassay, LFI), 메트릭스보조레이저 탈착/이온화이온사이클론 공명 질량분석법(matrix assisted laser desorption/ionisation time of flight mass spectrometry, MALDI-TOF MS)을 통해 표현형을 측정하는 분자기반 방법들이다. CRE, 특히 CPE의 적절한 시기에 정확한 탐지는 감염의 임상 치료 및 예방에 필수적이다. 다양한 표현형 검출방법 및 유전자-기반 검출방법이 카바페넴의 신속한 검출을 위해 이용 가능하며, 이들은 임상 미생물학 실험실에서 일상적으로 사용된다. 신속한 처리 시간으로 현장에서 치료를 위한 검사 방법을 사용하는 CRE에 대한 능동적인 감시활동에서 카바페넴분해효소를 생성하는 CRE의 탐지는 중요한 가치를 갖는다. 따라서 카바페넴분해효소의 확산을 통제하기 위해서는 전세계의 많은 검사실에서 신뢰할 수 있고 신속하고 고효율적이며, 간편하고 저비용의 검사법을 사용해야 할 것이다. 환자의 적용에서도 최적의 효과를 가지려면 CRE에 대한 신속한 검사를 통해 항균제의 관리 개입이나 다양한 형태의 임상 의사의 치료에 결정적인 지원을 재현성있게 나타나야 할 것이다. 최적의 검사법을 위해서는 보완되는 검사법을 결합하여 다양한 내성 박테리아 종을 감별하고 다양한 종류의 카바페넴분해효소의 유전적 다양성을 발굴하여 최상의 감염관리 전략을 포괄하는 시스템이 마련되어야 할 것으로 사료된다.

Keywords

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