2003∼2007년 한 대학병원 혈액배양에서 분리된 장알균의 항균제 저항성 및 Vancomycin 내성 장알균 균혈증에 관여하는 위험인자 분석 = Antimicrobial Resistance of Enterococcal Isolates from Blood and Risk Factors for Vancomycin Resistant Enterococcal Bacteremia in a Tertiary Care University Hospital from 2003 to 2007

다국어 초록 (Multilingual Abstract)

Background: In Korea, a sudden increase in vancomycin-resistant enterococci (VRE) infection has been noted since the late 1990s. This study was conducted to describe the antimicrobial resistances of enterococcal blood isolates and to identify risk factors associated with VRE bacteremia in a tertiary care university hospital over a recent five-year period.
Methods: This study was conducted to analyze the antimicrobial susceptibilities of enterococcal blood isolates by year from January 2003 to December 2007. Multivariate logistic regression analysis was used to investigate factors associated with VRE bacteremia.
Results: A total of 225 enterococcal strains (44.7%Enterococcus faecalis, 42.4% Enterococcus facium,5.9% Enterococcus casseliflavus, and 4.7% Enterococcus gallinarum) were detected in blood, 55 of which (21.6%) were resistant to vancomycin. In 2004and 2005, the resistance rates for vancomycin and teicoplanin (33.3% and 27.3%; 34.4% and 23.0%, respectively)increased. In 2003, 2006, and 2007, the resistance rates for vancomycin and teicoplanin (8.7% and 8.7%; 19.0% and 14.3%; 13.5% and 11.5%, respectively) decreased relative to those of the previous years. When 55 patients with VRE bacteremia were compared with 55 patients with vancomycin-susceptible enterococcal bacteremia using multivariate analysis, E. faecium bacteremia (OR 12.624, P＜0.001) and enterococcal bacteremia caused by species other than E. faecium and E. faecalis (OR 21.473, P=0.011) were found to be statistical risk factors. Among several infection control activities, the restricted uses of vancomycin and quinupristin-dalfopristin decreased the vancomycin resistance rate from 27.78% to 15.50% (P=0.0257).
Conclusion: VRE bacteremia would be effectively controlled via infection control activities based on studies regarding risk factors associated with VRE bacteremia. (Korean J Clin Microbiol 2010;13:59-67)

참고문헌 (Reference)

1 안균열, "환자의 혈액배양에서 분리된 균종과 항균제 감수성의 변화추이" 대한임상미생물학회 9 (9): 42-50, 2006

2 이연주, "일개 대학병원세 8년(1994-2001) 동안 반코마이신 내성 장구균(VRE) 감염 환자의 임상상 및 사망 위험요인 분석" 대한감염학회 35 (35): 249-255, 2003

3 Lucas GM, "Vancomycin-resistant and vancomycin-susceptible enterococcal bacteremia: comparison of clinical features and outcomes" 26 : 1127-1133, 1998

4 Edmond MB, "Vancomycin-resistant Enterococcus faecium bacteremia: risk factors for infection" 20 : 1126-1133, 1995

5 Edmond MB, "Vancomycin-resistant Enterococcus faecium bacteremia: risk factors for infection" 20 : 1126-1133, 1995

6 전재범, "Vancomycin-Resistant Enterococcal Bacteremia in a Hematology Unit: Risk Factors for Mortality and Impact of Adequate Antimicrobial Therapy on Mortality" 대한감염학회 39 (39): 133-141, 2007

7 Kang BK, "The trends of the species and antimicrobial susceptibility of bacteria and fungi isolated from blood cultures (1986-1996)" 18 : 57-64, 1998

8 Fridkin SK, "The effect of vancomycin and third-generation cephalosporins on prevalence of vancomycin-resistant enterococci in 126 U.S. adult intensive care units" 135 : 175-183, 2001

9 Park JW, "Susceptibility tests of vancomycin-resistant enterococci" 24 : 133-137, 1992

10 Aumeran C, "Successful control of a hospital-wide vancomycin-resistant Enterococcus faecium outbreak in France" 27 : 1061-1064, 2008

11 Olivier CN, "Risk of vancomycin-resistant Enterococcus (VRE) bloodstream infection among patients colonized with VRE" 29 : 404-409, 2008

12 Karlowsky JA, "Prevalence and antimicrobial susceptibilities of bacteria isolated from blood cultures of hospitalized patients in the United States in 2002" 3 : 7-, 2004

13 Leclercq R, "Plasmid-mediated resistance to vancomycin and teicoplanin in Enterococcus faecium" 319 : 157-161, 1988

14 Clinical and Laboratory Standards Institute, "Performance standards for antimicrobial susceptibility testing; Sixteenth Informational Supplement M100-S16" Clinical and Laboratory Standards Institute 2006

15 Kuhn I, "Occurrence and relatedness of vancomycin-resistant enterococci in animals, humans, and the environment in different European regions" 71 : 5383-5390, 2005

16 Quale J, "Manipulation of a hospital antimicrobial formulary to control an outbreak of vancomycin-resistant enterococci" 23 : 1020-1025, 1996

17 Grayson ML, "Increasing resistance to beta-lactam antibiotics among clinical isolates of Enterococcus faecium: a 22-year review at one institution" 35 : 2180-2184, 1991

18 Erlandson KM, "Impact of the more-potent antibiotics quinupristin-dalfopristin and linezolid on outcome measure of patients with vancomycin-resistant Enterococcus bacteremia" 46 : 30-36, 2008

19 이경원, "Further Increase of Vancomycin-Resistant Enterococcus faecium, Amikacin- and Fluoroquinolone-Resistant Klebsiella pneumoniae, and Imipenem-Resistant Acinetobacter spp. in Korea" 연세대학교의과대학 47 (47): 43-54, 2006

20 Shay DK, "Epidemiology and mortality risk of vancomycin-resistant enterococcal bloodstream infections" 172 : 993-1000, 1995

21 Peset V, "Epidemiological, microbiological, clinical, and prognostic factors of bacteremia caused by high-level vancomycin-resistant Enterococcus species" 19 : 742-749, 2000

22 강성하, "Characteristics of Microorganisms Isolated from Blood Cultures at a University Hospital Located in an Island Region During 2003∼2007" 대한임상미생물학회 11 (11): 11-17, 2008

23 Garbutt JM, "Association between resistance to vancomycin and death in cases of Enterococcus faecium bacteremia" 30 : 466-472, 2000

24 Oster SE, "Ampicillin-resistant enterococcal species in an acute-care hospital" 34 : 1821-1823, 1990

25 Bhavnani SM, "A nationwide, multicenter, case-control study comparing risk factors, treatment, and outcome for vancomycin-resistant and -susceptible enterococcal bacteremia" 36 : 145-158, 2000

26 이혁민, "2005∼2006년 국내 12개 병원에서 분리된 주요 세균의 항균제 내성률" 대한임상미생물학회 10 (10): 59-69, 2007

27 이혁민, "2004년도 국내 12개 병원에서 분리된 주요 세균의 항균제 내성율" 대한임상미생물학회 8 (8): 66-73, 2005

28 고은미, "1994-2003년 한 대학병원 혈액배양에서 분리된 미생물의 분포 및세균의 항균제 감수성 양상" 대한진단검사의학회 27 (27): 265-275, 2007