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Vancomycin 내성 장구균의 분포 및 Vancomycin, penicillin 및 Gentamicin의 병용 효과
김활웅 ( Hal Woong Kim ),이위교 ( Wee Gyo Lee ),유기원 ( Ki Won Ryu ),김각현 ( Kag Hyu Kim ),관연식 ( Yun Sik Kwak ) 대한임상검사과학회 1998 대한임상검사과학회지(KJCLS) Vol.30 No.3
Infections caused by vancomycin-resistant enterococci (VRE) are becoming increasingly prevalent throughout the world Because of the resistance of vancomycin resistance is troublesome. The optimum drug regimen for treatment of infections due to VRE is not known Very few data have been published concerning in VRE-infected patients. The combined regimen may offer a treatment for patients infected with VRE. The IXJI1Xl8e of this study was to examine the incidence of VRE among total enterococci from clinical specimen and investigate the antimicrobial synergistic killing of clinical isolates of VRE belonging to genotypic resistance classes vanA, vanB, and vanC. A total of 1,286 enterococcal isolates from patients over a period of 12 months were screened for vancomycin resistance using brain heart infusion agar plates supplemented with 6 ug/ml, of vancomycin. The incidence of VRE among enterococcal isolates was calculated form microbiology statistics program Nine strains of VRE and 2 strains of vancomycin-susceptible enterococci were utilized in this study. Minimal inhibitory concentrations (MIC) were determined by agar dilution method Synergistic inhibition of growth was assessed by addition vancomycin, penicillin, gentamicin, or combinations of these antibiotics to cultures in the early loganthmic phase of growth Synergy was defined as a decrease in CFU/mL by at least 2 log10 after 24h compared with the effect of the most active single agent In the 12 months, the incidence of VRE was 3.2%. Among 9 strains, analyses, the frequency of uanB, uanC1, and uanC2 types was 2, 4, and 3 strains, respectively, Vancomycin-penicillin-gentamicin, and vancomycin-penicillin resulted in 2 or more logs of killing above that the most effective single agent for all vanA and vanB strains. All vanC strains were resistant to any antibiotics combination. Continued vigilance, strict enforcement of infection control, and curtailment of vancomycin use seem to be our best approaches to controlling this increasingly important problem For this purposes, accurate and timely detection of vancomycin resistance and periodic investigation for incidence is essential. Triple combination therapy and vancomycin plus penicillin regimen may be effective for the treatrrent of infections caused by vancomyin-resistant enterococci belonging to genotypic classes vanA and vanB. Further studies are needed for the new therapeutic regimen against vanC strains.
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