잠시만 기다려 주세요. 로딩중입니다.

국내 환자에서 분리된 Orientia tsutsugamushi에서doxycycline 내성

Doxycycline Resistance in Orientia tsutsugamushi Isolated from Korean Patients

감염과화학요법 2008년 40권 5호 p.259 ~ 265
김은실, 강재승, 이진수, 정문현, 김미경, 이혜명, 길세희,
소속 상세정보
김은실 ( Kim Eun-Sil ) - 부천대성병원 내과
강재승 ( Kang Jae-Seung ) - 인하대학교 의과대학 미생물학교실
이진수 ( Lee Jin-Soo ) - 인하대학교 의과대학 내과학교실
정문현 ( Chung Moon-Hyun ) - 인하대학교 의과대학 내과학교실
김미경 ( Kim Mee-Kyung ) - 인하대학교 의과대학 임상의학연구실
이혜명 ( Lee Hye-Myung ) - 인하대학교 의과대학 임상의학연구실
길세희 ( Kil Se-Hee ) - 인하대학교 의과대학 임상의학연구실

Abstract


Background : Doxycycline has been the drug of choice for the treatment of scrub typhus. However, scrub typhus with poor response to doxycycline was first reported in Thailand in 1996. To date, it is not known whether doxycycline resistant scrub typhus is present in Korea. To investigate the doxycycline resistance of scrub typhus in Korea, we performed an experiment to evaluate the degree of growth inhibition of Orientia tsutsugamushi at the minimal inhibitory concentration (MIC) of doxycycline.

Materials and Methods : 37 isolates of Orientia tsutsugamushi were collected from Korean patients with scrub typhus during 10 year period (from 1997 to 2007). 34 isolates consisted of Boryong serotype or related serotypes. These strains were stained with FS15, a monoclonal antibody against the linear epitope on the protein located at the outer membrane of O. tsutsugamushi. Three isolates were confirmed as serotype Gilliam, which was stained by anti-Gilliam antibody. The antibodystainable 35 isolates were incubated in media containing 0.1 and 0.2 μg/mL of doxycycline for 3
days. Then the growth indices of Orientia were measured by flow cytometry. If the growth index was greater than 10%, the isolate was tentatively classified as an isolate resistant to doxycycline and its MIC was measured.

Results : Demographic and treatment data were similar to the results of previous reports. Infection was mainly observed in Inchon and the Chungcheongnam province. No patient showed delayed response to antibiotics. Of 35 hospitalized patients, 4 (11.4%) were managed at the intensive care unit, and 1 (2.9%) died of nosocomial pneumonia. All the 2 patients whose isolates were serotype Gilliam Yonchon/Ikeda-like strain were managed at the intensive care unit.
Six of the 34 isolates from Korean patients exhibited growth indices greater than 10% at the MIC of doxycycline; however, the MICs of these isolates did not exceed 0.2 μg/mL. One isolate of serotype Gilliam showed an MIC of 0.0125 ug/mL, which seemed to be underestimated due to weak fluorescence of the anti-Gilliam antibody.

Conclusions : Although the number of tested isolates is small, insensitivity of scrub typhus to doxycycline is not a major reason for treatment failure in Korea. Serotype Gilliam, especially Yochon/ Ikeda-like strain, may be associated with severe form of scrub typhus. More studies concerning the antibiotic susceptibility for serotype Gilliam are warranted.

키워드

Orientia tsutsugamushi;Scrub typhus;Doxycycline;Resistance

원문 및 링크아웃 정보

 

등재저널 정보

KCI
KoreaMed
KAMS