호흡기질환 환자에서 분리한 Mycoplasma pneumoniae의 Quinolone계와 Macrolide계 항생물질에 대한 다제 저항성

Abstract

호흡기질환 환자의 상기도 도말물로 부터 분리 동정된 M. pneumoniae 116균주의 moxifloxacin, levofloxacin, sparfloxacin, ofloxacin, ciprofloxacin, clarithromycin minocycline, erythromycin, josamycin, and tetracycline에 대한 감수성 검사를 실시하였다. 각 항생물질에 대한 저항성 균주의 기준은 <TEX>$MIC{\pm}1.0$</TEX> <TEX>${\mu}g/ml$</TEX> 로 하였으며, 초기 MIC와 최종 MIC를 구분하여 다제 저항성 균주의 분포를 분석하였다. 초기 MIC의 결과로 분리된 균주의 단일 약제에 대한 저항성은 ciprofloxacin이 79.3%, ofloxacin이 53.5%, clarithromycin이 10.3%, erythromycin이 7.8%이었으며, 2가지 약제에 저항성은 ofloxacin과 ciprofloxacin이 42.2%, ciprofloracin과 clarithromycin이 9.5%이었으며, 3가지 약제에 저항성은 erythromycin, ofloxacin과 ciprofloxacin이 6.9%, ofloxacin, ciprofloxacin과 clarithromycin이 6.0%이었다. 최종 MIC의 결과로 분리균의 단일 약제에 대한 저항성은 tetracycline, ciprofloxacin, ofloxacin이 각각 91.4%, minocycline이 89.7%, erythromycin이 68.1%, josamycin이 52.6%, clarithromycin이 28.5%, sparfloxacin이 11.2%이었으며, 2가지 약제에 저항성인 균의 분포는 <TEX>$20.7{\sim}91.4%$</TEX>, 3가지약제에 저항성인 규의 분포는 <TEX>&28.5{\sim}89.7%$</TEX>, 4가지 약제에 저항성인 균의 분포는 2.6%, 5가지 약제에 저항성인 균은 <TEX>$2.6{\sim}21.6%$</TEX>, 6가지 약제에 저항성인 균은 <TEX>$0.9{\sim}24.1%$</TEX>이었으며, 7가지 약제에 저항성인 균은 <TEX>$0.9{\sim}2.6%$</TEX>이었으며, 8종류 약제에 저항성인 균도 1.7%있었다. 이상의 결과로 국내에서 분리된 M. pneumoniae 균주는 적게는 1-4 종류의 항생제에, 많게는 5-8 종류의 항생제에 저항성인 균주가 있으므로 마이코플라스마폐렴 환자를 치료할때는 macrolide계나 quinolone계의 항생제 선택에 신중을 기하여야 하며, 가급적이면 항생제 감수성 검사를 실시하여 적절한 항생제를 선택함으로써 저항성균의 출현율을 줄일 수 있고 효율적인 치료도 할 수 있도록 하여야 할 것으로 생각된다. Antimicrobial susceptibility test of the 116 strains of Mycoplasma pneumoniae isolates were performed by a broth micro-dilution method against to moxifloxacin, levofloxacin, sparfloxacin, ofloxacin, ciprofloxacin, clarithromycin minocycline, erythromycin, josamycin, and tetracycline. The initial-minimum inhibitory concentration (I-MIC) was evaluated as the lowest concentration of antimicrobial agents that prevented a color change in the medium at that time when the drug-free growth control, about 7 days after incubation, and the final-minimum inhibitory concentration (F-MIC) was defined a color change about 14 days after incubation. The evaluation to the drug-resistant M. pneumoniae isolates were determined the <TEX>$MIC{\pm}1.0$</TEX> <TEX>${\mu}g/ml$</TEX> of each antimicrobial agent. According to the I-MIC, single drug-resistant M. pneumoniae strains to ciprofloxacin, ofloxacin, clarithromycin and erythromycin were 79.3, 53.5, 10.3, and 7.8%, respectively. Two kinds of drug-resistant M. pneumoniae strains to ofloxacin and ciprofloxacin, or ciprofloxacin and clarithromycin were 42.2 and 9.5%. Three kinds of drug-resistant M. pneumoniae strains to erythromycin, ofloxacin, and ciprofloxacin, or ofloxacin, ciprofloxacin and clarithromycin were 6.9 and 6.0% . According to the F-MIC, single drug-resistant M. pneumoniae strains to tetracycline, ciprofloxacin, ofloxacin, minocycline,erythromycin, josamycin, clarithromycin and sparfloxacin were 91.4, 91.4, 91.4, 89.7, 68.1, 52.6, 28.5, and 11.2%, respectively. The incidence of two kinds of drug-resistant M. pneumoniae strains were from 20.7% to 91.4%, three kinds of drug-resistant M. pneumoniae strains were from 28.5% to 89.7%, four kinds of drug-resistant M. pneumoniae strains were 2.6%, five kinds of drug-resistant M. pneumoniae were from 2.6% to 21.6%, six kinds of drug-resistant M. pneumoniae strains were from 0.9% to 24.1%, seven kinds of drug-resistant M. pneumoniae strains were from 0.9% to 2.6%, and eight kinds of drug-resistant M. pneumoniae strains were 1.7%. These results suggest that sparfloxacin, moxifloxacin and levofloxacin might be promising antimicrobial agents for the treatment of M. pneumoniae infection in Korea. However, most strains of M. pneumoniae isolates were single or multi-resistance pattern to the other tested antimicrobial agents. Therefore, tetracycline, minocycline, erythromycin, clarithromycin, and second-generation quinolones are more carefully used to patients with M. pneumoniae infection in Korea.