• Tuberculosis and Respiratory Diseases
• /
• 제60권2호
• /
• pp.228-234
• /
• 2006

연구배경 : A. baumannii는 중환자실내의 원내감염의 중요 원인균으로 인식되고 있으며, 원내 폐렴, 요로 감염증, 균혈증 등을 일으킨다. 현재 이 균의 다약제 내성이 문제되고 있으며 특히 carbapenem에 내성을 보이고 있는 것이 가장 큰 문제가 되고 있다. 이 연구의 목적은 중환자실 환자의 객담에서 배양된 A. baumannii 중 carbapenem 내성군과 감수성군 두 군으로 나누어 위험인자를 알아보고 임상적 특징을 비교 및 분석하는 것이다. 방 법 : 2003년 1월 1일부터 2003년 12월 31일까지 강원대학교 중환자실에 입원한 성인 환자들 중 객담 배양 검사상 A. baumannii가 한 번이라도 검출된 환자들을 대상으로 챠트 기록을 통한 후향적 분석을 하였다. 위험인자로 연령, 성별, APACHE II score, 동반질환, 사용한 항생제, 재원기간, 중환자실 재원기간, Clinical Pulmonary Infection Score, 인공호흡기 여부를 평가하였다. 결 과 : 총 49명으로 A. baumannii에 대한 carbapenem 감수성군은 23명 내성군은 26명이었다. 단일변량분석에서는 신장 질환, 이전의 aminoglycoside 및 carbapenem 사용력이 통계적인 의미를 보였고 다변량분석에서는 이전의 aminoglycoside 사용력은 carbapenem 내성과 음의 상관관계를(p=0.026; OR, 0.18; CI, 0.04 to 0.82), 이전의 carbapenem 사용력은 carbapenem 내성과 양의 상관관계를(p=0.024; OR, 8.17; CI 1.32 to 50.68) 보여주었다. 사망률에서는 양 군에서 유의한 차이를 보이지 않았다(30 vs 42%, P=0.39). 결 론 : Carbapenem 내성 A. baumannii의 발생의 위험인자로 이전의 aminoglycoside와 carbapenem 사용력이 있으며 carbapenem 사용 시 A. baumannii의 carbapenem 내성정도가 증가함을 볼 수 있다.

• Journal of Microbiology and Biotechnology
• /
• 제25권7호
• /
• pp.1154-1162
• /
• 2015

The emergence of carbapenem resistance among Pseudomonas aeruginosa is an increasing problem in many parts of the world. In particular, metallo-$\beta$-lactamases (MBLs) and AmpC $\beta$lactamases are responsible for high-level resistance to carbapenem and cephalosporin. We studied the diversity and frequency of $\beta$-lactamases and characterized chromosomal AmpC $\beta$lactamase from carbapenem-resistant P. aeruginosa isolates. Sixty-one carbapenem-resistant P. aeruginosa isolates were collected from patients in a tertiary hospital in Daejeon, Korea, from January 2011 to June 2014. Minimum inhibitory concentrations (MICs) of four antimicrobial agents were determined using the agar-dilution method. Polymerase chain reaction and sequencing were used to identify the various $\beta$-lactamase genes, class 1 integrons, and chromosomally encoded and plasmid-mediated ampC genes. In addition, the epidemiological relationship was investigated by multilocus sequence typing. Among 61 carbapenem-resistant P. aeruginosa isolates, 25 isolates (41.0%) were MBL producers. Additionally, 30 isolates producing PDC (Pseudomonas-derived cephalosporinase)-2 were highly resistant to ceftazidime (MIC₅₀ = $256{\mu}g/ml$) and cefepime (MIC₅₀ = $256{\mu}g/ml$). Of all the PDC variants, 25 isolates harboring MBL genes showed high levels of cephalosporin and carbapenem resistance, whereas 36 isolates that did not harbor MBL genes revealed relatively low-level resistance (ceftazidime, p < 0.001; cefepime, p < 0.001; imipenem, p = 0.003; meropenem, p < 0.001). The coexistence of MBLs and AmpC $\beta$-lactamases suggests that these may be important contributing factors for cephalosporin and carbapenem resistance. Therefore, efficient detection and intervention to control drug resistance are necessary to prevent the emergence of P. aeruginosa possessing this combination of $\beta$-lactamases.

• 대한임상검사과학회지
• /
• 제50권4호
• /
• pp.406-413
• /
• 2018

최근 P. aeruginosa의 carbapenem에 대한 내성은 전 세계적으로 증가하고 있는 실정이다. 특히 $metallo-{\beta}-lactamases$ (MBLs)는 carbapenem의 고도 내성에 관여하고 있는 것으로 보고되고 있다. 한편, Sequence type 235 (ST235)는 다제내성 클론으로써 국제적으로 보고되고 있으며, IMP-6와 VIM-2 유전자의 확산에도 관여하는 것으로 알려져 있다. 본 연구에서는 2008년 3월부터 2014년 6월까지, 대전지역의 3차 병원에서 분리된 carbapenem 내성 P. aeruginosa에서 MBL 유전자를 분석하고 이에 대한 역학관계를 조사하고자 하였다. 항균제 감수성 양상은 디스크 확산법으로 확인하였고, MBL 유전자의 분석을 위해 PCR과 염기서열분석을 수행하였다. 더불어, 역학 관계를 조사하기 위해 multilocus sequence typing (MLST)를 실시하였다. 110 균주의 carbapenem 내성 P. aeruginosa 중, 32균주(29.1%)가 MBL를 생성하였고, IMP-6 (29균주, 90.6%)가 주요하게 확인되었다. VIM-2는 3균주(9.4%)에서 확인되었으며, 모두 ST357로 확인되었다. IMP-6를 생성하는 P. aeruginosa는 모두 다제내성을 보였고, ST235로 확인되었다. ST235 (55균주, 50.0%)는 가장 높은 비율로 확인된 클론이며 7년 동안 지속적으로 확인되었다. 이러한 다제내성 ST235의 확산을 방지하기 위해, carbapenem의 과도한 사용을 제한하고, 지속적으로 모니터링하는 전략이 개발되어야 할 것으로 사료된다.

• 대한의생명과학회지
• /
• 제25권3호
• /
• pp.288-292
• /
• 2019

In vitro antimicrobial activities of hot water extracts of Camellia sinensis (L.) O. Kuntze, for carbapenem-resistant Enterobacteriaceae (CRE) were compared to commonly used conventional antimicrobial agents. CRE was not only resistant to imipenem, meropenem or ertapenem, but also to various antimicrobial agents, such as amikacin (> $128{\mu}g/mL$). The hot water extracts of Camellia sinensis (L.) O. Kuntze had the lowest MIC ($0.06{\sim}0.5{\mu}L/mL$) of the carbapenem-resistant E. coli, K. pneumoniae, and Enterobacter spp. tested, and it was possible more potent than various conventional antimicrobial agents. Synergistic combinations of the extract with used commonly antimicrobial agents might even improve its antimicrobial chemotherapy property.

• Journal of Microbiology and Biotechnology
• /
• 제31권10호
• /
• pp.1383-1392
• /
• 2021

Carbapenem-resistant Enterobacteriaceae (CRE) that produce Klebsiella pneumoniae carbapenemase are increasingly reported worldwide and have become more and more resistant to nearly all antibiotics during the past decade. The emergence of K. pneumoniae strains with decreased susceptibility to carbapenems, which are used as a last resort treatment option, is a significant threat to hospitalized patients worldwide as K. pneumoniae infection is responsible for a high mortality rate in the elderly and immunodeficient individuals. This study used Lactobacillus fermentum as a candidate probiotic for treating CRE-related infections and investigated its effectiveness. We treated mice with L. fermentum originating from the vaginal fluid of a healthy Korean woman and evaluated the Lactobacilli's efficacy in preventive, treatment, nonestablishment, and colonization mouse model experiments. Compared to the control, pre-treatment with L. fermentum significantly reduced body weight loss in the mouse models, and all mice survived until the end of the study. The oral administration of L. fermentum after carbapenem-resistant Klebsiella (CRK) infection decreased mortality and illness severity during a 2-week observation period and showed that it affects other strains of CRK bacteria. Also, the number of Klebsiella bacteria was decreased to below 5.5 log₁₀ CFU/ml following oral administration of L. fermentum in the colonization model. These findings demonstrate L. fermentum's antibacterial activity and its potential to treat CRE infection in the future.

• 대한의생명과학회지
• /
• 제27권2호
• /
• pp.59-68
• /
• 2021

Multidrug-resistant strain of Acinetobacter baumannii (MDRAB) is an emerging pathogen in health care facilities, preventing MDRAB is a public health concern. We conducted this experiment on a clinical isolate of A. baumannii with two main goals: the role of the efflux pump system in the stress provision of carbapenem and the response to the transcription level of the efflux pump gene. A total of 34 strains of A. baumannii was isolated from the Yangsan Hospital of Pusan National University. First, when we compared and observed the expression of the efflux pump gene and antibacterial resistance to carbapenem, a strong correlation was observed between carbapenem resistance and overexpression of adeB (P=0.0056). Second, a correlation between the efflux pump and concentration gradient and tolerance to carbapenem stress at the AdeABC efflux pump genes transcription level was confirmed. Our results revealed that the expression of the AdeABC efflux pump is an important resistance determinant in obtaining antibiotic resistance of the carbapenem group in A. baumannii.

• 한국미생물·생명공학회지
• /
• 제48권3호
• /
• pp.389-398
• /
• 2020

The prevalence of carbapenem-resistant Enterobacteriaceae (CRE) is increasing globally, resulting in high mortality rates. Although CRE is a relatively recent problem in Korea (the first case was not diagnosed until 2010), it is responsible for serious morbidities at an alarming rate. In this study, we carried out a molecular genetic analysis to determine the incidence of CRE and carbapenemase-producing Enterobacteriaceae (CPE) at a general hospital in Korea between August 2017 and August 2019. Forty strains of CPE were isolated from various clinical specimens and analyzed via antimicrobial susceptibility testing, polymerase chain reaction to detect β-lactamase genes, deoxyribonucleic acid sequencing, multilocus sequence typing, curing testing, and conjugal transfer of plasmids. The results demonstrated that all 40 isolates were multidrug-resistant. The fluoroquinolone susceptibility test showed that 75% of the Enterobacteriaceae isolates were resistant to ciprofloxacin, whereas 72.5% were resistant to trimethoprim-sulfamethoxazole. Further, conjugation accounted for 57.5% of all resistant plasmid transfer events, which is 4.3-fold higher than that observed in 2010 by Frost et al. Finally, the high detection rate of transposon Tn4401 was associated with the rapid diffusion and evolution of CPE. Our results highlight the rapid emergence of extensively drugresistant strains in Korea and emphasize the need for employing urgent control measures and protocols at the national level.

• Pediatric Infection and Vaccine
• /
• 제18권1호
• /
• pp.97-102
• /
• 2011

Acinetobactor baumanii 는 기회 감염균으로 carbapenem의 사용이 증가하면서 MDRAB와 같은 내성균으로 출현하고 있다. 저자들은 경희의료원에서 carbapenem을 투약받지 않았더라도 집중치료실에 장기간 입원하여 기관삽관과 인공호흡기 치료를 받거나 침습적인 수술을 받아 도관을 유지하는 환아에서 MDRAB가 동정되었다는 것을 확인하였다. carbapenem을 사용하지 않았더라도 장기간 집중치료실에 입원할 것으로 예상되는 환자들에게 원내전파를 통한 감염을 최소화하기 위하여 원내감염관리에 최선을 다해야 할 것이기에 이상의 증례를 통하여 보고한다.

• Tuberculosis and Respiratory Diseases
• /
• 제72권4호
• /
• pp.360-366
• /
• 2012

Background: Carbapenem-resistance is rapidly evolving among the pathogenic microbes in intensive care units (ICUs). This study aimed to determine annual trend of carbapenem-resistance in the ICU for 4 years, since the opening of a university-affiliated hospital in South Korea. Methods: From 2005 to 2008, microbial samples from consecutive 6,772 patients were screened in the ICU. Three hundred and ninety-seven patients (5.9%) and their first isolates of carbapenem-resistant pathogens were analyzed. Results: The percentage of patients infected with carbapenem-resistant organisms increased constantly during the initial three years (2.3% in 2005, 6.2% in 2006, 7.8% in 2007), then it declined to 6.5% in 2008. Acute Physiology and Chronic Health Evaluation (APACHE) III score at admission was $58.0{\pm}23.5$, the median length of the ICU stay was 37 days, and the mortality rate was 37.5%. The sampling sites were endotracheal suction (67%), catheterized urine (17%), wound (6%) and others (10%). Bacteria with carbapenem-resistance were Pseudomonas aeruginosa (247 isolates, 62%), Acinetobacter baumannii (117 isolates, 30%), Enterobacteriaceae (12 isolates, 3%), and others (21, 5%). Of note, peak isolation of carbapenem-resistant microorganisms in medical ICU was followed by the same epidemic at surgical ICU. Conclusion: Taken together, carbapenem-resistant pathogens are of growing concern in the ICU.

• 대한간호학회지
• /
• 제50권4호
• /
• pp.621-630
• /
• 2020

Purpose: This study was aimed to evaluate the external validity of a carbapenem-resistant Enterobacteriaceae (CRE) acquisition risk prediction model (the CREP-model) in a medium-sized hospital. Methods: This retrospective cohort study included 613 patients (CRE group: 69, no-CRE group: 544) admitted to the intensive care units of a 453-beds secondary referral general hospital from March 1, 2017 to September 30, 2019 in South Korea. The performance of the CREP-model was analyzed with calibration, discrimination, and clinical usefulness. Results: The results showed that those higher in age had lower presence of multidrug resistant organisms (MDROs), cephalosporin use ≥ 15 days, Acute Physiology and Chronic Health Evaluation II (APACHE II) score ≥ 21 points, and lower CRE acquisition rates than those of CREP-model development subjects. The calibration-in-the-large was 0.12 (95% CI: - 0.16~0.39), while the calibration slope was 0.87 (95% CI: 0.63~1.12), and the concordance statistic was .71 (95% CI: .63~.78). At the predicted risk of .10, the sensitivity, specificity, and correct classification rates were 43.5%, 84.2%, and 79.6%, respectively. The net true positive according to the CREP-model were 3 per 100 subjects. After adjusting the predictors' cutting points, the concordance statistic increased to .84 (95% CI: .79~.89), and the sensitivity and net true positive was improved to 75.4%. and 6 per 100 subjects, respectively. Conclusion: The CREP-model's discrimination and clinical usefulness are low in a medium sized general hospital but are improved after adjusting for the predictors. Therefore, we suggest that institutions should only use the CREP-model after assessing the distribution of the predictors and adjusting their cutting points.