{"id":{"repo_id":"ajou","oai_identifier":"oai:repository.ajou.ac.kr:201003/7643"},"canonical_url":"https://search.dev.ndltd.org/etd/ajou/oai:repository.ajou.ac.kr:201003/7643","repository":{"repo_id":"ajou","name":"Ajou University","base_url":"http://repository.ajou.ac.kr/oai/request"},"display":{"title":"Molecular Characteristics and Dissemination Mechanism of Vancomycin-Resistant Enterococci: A Tertiary vs. Non-Tertiary Health Care Hospitals","abstract":"Vancomycin-resistant enterococci (VRE) have been endemic in Korea as a nosocomial pathogen. The aim of this study was to examine genetic relatedness and dissemination mechanism by comparative analysis of the antimicrobial and biomolecular characteristics of VRE isolates from tertiary and non-tertiary health care hospitals in Korea. We studied a total of 54 clinical vancocmycin-resistant Enterococcus faecium (VREF) isolates: 18 isolates collected from a tertiary health care hospital (Tertiary) (1,087 beds), and 36 isolates from 20 non-tertiary health care hospitals (Non-Tertiaries) (0-544 beds) in diverse geographical areas of Korea from October 2010 to April 2011. The mimimum inhibitory concentration (MIC)s of vancomycin and teicoplanin, multiplex PCR for resistance genotype, structural analysis of Tn1546, multilocus sequence typing (MLST), virulence factor (esp), and dendrogram of repetitive extragenic palindromic PCR (rep-PCR) were analyzed in all VREF isolates. All the isolates harboured the vanA gene. 15 isolates (41.7%) from Non-Tertiaries and 13 isolates (72.2%) from the Tertiary showed VanB phenotype (P < 0.05). All isolates were divided into 3 main types according to the distribution of IS elements (IS1542 and IS1216V) integrated into Tn1546. The major type of isolates from the Non-Tertiaries was type II (80.6%). Type III was the most prevalent among the isolates from the Tertiary (50.0%). IS1542 was inserted at position 3925 in the orf2-vanR intergenic region. The position of insertion site of IS1216V in the vanX-vanY intergenic region was variable in the Tertiary. All the isolates belonged to clonal complex 17 (CC17), associated with nosocomial infection worldwide. Sequence type (ST) 17 (38.9%) was predominant in Non-Tertiaries. There were 3 largest ST groups of ST18 (27.8%), ST192 (22.2%), and ST78 (22.2%) in the Tertiary. They are single or double locus variant of ST17. The Esp gene was found in 30 isolates (83.3%) from Non-Tertiaries and 12 isolates (66.7%) from the Tertiary (P > 0.05). The dendrogram created using rep-PCR results showed no genetic relatedness between the VREF isolates. These results suggest horizontal transmission of the vanA gene may have occurred among genetically diverse strains of E. faecium between Tertiaries and Non-Tertiaries in Korea.","abstract_html":"Vancomycin-resistant enterococci (VRE) have been endemic in Korea as a nosocomial pathogen. The aim of this study was to examine genetic relatedness and dissemination mechanism by comparative analysis of the antimicrobial and biomolecular characteristics of VRE isolates from tertiary and non-tertiary health care hospitals in Korea. We studied a total of 54 clinical vancocmycin-resistant Enterococcus faecium (VREF) isolates: 18 isolates collected from a tertiary health care hospital (Tertiary) (1,087 beds), and 36 isolates from 20 non-tertiary health care hospitals (Non-Tertiaries) (0-544 beds) in diverse geographical areas of Korea from October 2010 to April 2011. The mimimum inhibitory concentration (MIC)s of vancomycin and teicoplanin, multiplex PCR for resistance genotype, structural analysis of Tn1546, multilocus sequence typing (MLST), virulence factor (esp), and dendrogram of repetitive extragenic palindromic PCR (rep-PCR) were analyzed in all VREF isolates. All the isolates harboured the vanA gene. 15 isolates (41.7%) from Non-Tertiaries and 13 isolates (72.2%) from the Tertiary showed VanB phenotype (P &lt; 0.05). All isolates were divided into 3 main types according to the distribution of IS elements (IS1542 and IS1216V) integrated into Tn1546. The major type of isolates from the Non-Tertiaries was type II (80.6%). Type III was the most prevalent among the isolates from the Tertiary (50.0%). IS1542 was inserted at position 3925 in the orf2-vanR intergenic region. The position of insertion site of IS1216V in the vanX-vanY intergenic region was variable in the Tertiary. All the isolates belonged to clonal complex 17 (CC17), associated with nosocomial infection worldwide. Sequence type (ST) 17 (38.9%) was predominant in Non-Tertiaries. There were 3 largest ST groups of ST18 (27.8%), ST192 (22.2%), and ST78 (22.2%) in the Tertiary. They are single or double locus variant of ST17. The Esp gene was found in 30 isolates (83.3%) from Non-Tertiaries and 12 isolates (66.7%) from the Tertiary (P &gt; 0.05). The dendrogram created using rep-PCR results showed no genetic relatedness between the VREF isolates. These results suggest horizontal transmission of the vanA gene may have occurred among genetically diverse strains of E. faecium between Tertiaries and Non-Tertiaries in Korea.","abstract_has_math":false,"creators":["정, 민권"],"institution":null,"degree_name":null,"degree_level":null,"degree_discipline":null,"degree_department":null,"school":null,"contributors":["대학원 의학과","201024451"],"advisors":[],"committee_chairs":[],"committee_members":[],"year":2012,"date_issued":"2012-11-06T01:30:31Z","date_published":"2012-11-06T01:30:31Z","updated_at":"2026-07-24T00:51:39Z","subjects":["Vancomycin-resistant Enterococcus faecium","VRE","vanA","Tn1546","Multilocus sequence typing","MLST","esp","Rep-PCR"],"languages":["ko"],"rights":[],"rights_urls":[],"identifier_entries":[{"key":"dc:identifier","label":"Identifier","values":["http://dcoll.ajou.ac.kr:9080/dcollection/jsp/common/DcLoOrgPer.jsp?sItemId=000000012699","000000012699"],"render_values":[{"text":"http://dcoll.ajou.ac.kr:9080/dcollection/jsp/common/DcLoOrgPer.jsp?sItemId=000000012699","href":"http://dcoll.ajou.ac.kr:9080/dcollection/jsp/common/DcLoOrgPer.jsp?sItemId=000000012699","code":true},{"text":"000000012699","href":null,"code":true}]}]},"links":{"outbound_url":"http://repository.ajou.ac.kr/handle/201003/7643","outbound_label":"Repository record","outbound_source":"dc:identifier"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor","label":"Contributor","values":["대학원 의학과","201024451","정, 민권"]},{"key":"dc:creator","label":"Author","values":["정, 민권"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date","label":"Dc Date","values":["2012-11-06T01:30:31Z","2012"]},{"key":"dc:type","label":"Dc Type","values":["Thesis","Theses"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["Vancomycin-resistant Enterococcus faecium","VRE","vanA","Tn1546","Multilocus sequence typing","MLST","esp","Rep-PCR"]}]},{"id":"language_rights","label":"Language and Rights","entries":[{"key":"dc:language","label":"Dc Language","values":["ko"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier","label":"Identifier","values":["http://repository.ajou.ac.kr/handle/201003/7643","http://dcoll.ajou.ac.kr:9080/dcollection/jsp/common/DcLoOrgPer.jsp?sItemId=000000012699","000000012699"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description","label":"Description","values":["Vancomycin-resistant enterococci (VRE) have been endemic in Korea as a nosocomial pathogen. The aim of this study was to examine genetic relatedness and dissemination mechanism by comparative analysis of the antimicrobial and biomolecular characteristics of VRE isolates from tertiary and non-tertiary health care hospitals in Korea. We studied a total of 54 clinical vancocmycin-resistant Enterococcus faecium (VREF) isolates: 18 isolates collected from a tertiary health care hospital (Tertiary) (1,087 beds), and 36 isolates from 20 non-tertiary health care hospitals (Non-Tertiaries) (0-544 beds) in diverse geographical areas of Korea from October 2010 to April 2011. The mimimum inhibitory concentration (MIC)s of vancomycin and teicoplanin, multiplex PCR for resistance genotype, structural analysis of Tn1546, multilocus sequence typing (MLST), virulence factor (esp), and dendrogram of repetitive extragenic palindromic PCR (rep-PCR) were analyzed in all VREF isolates. All the isolates harboured the vanA gene. 15 isolates (41.7%) from Non-Tertiaries and 13 isolates (72.2%) from the Tertiary showed VanB phenotype (P < 0.05). All isolates were divided into 3 main types according to the distribution of IS elements (IS1542 and IS1216V) integrated into Tn1546. The major type of isolates from the Non-Tertiaries was type II (80.6%). Type III was the most prevalent among the isolates from the Tertiary (50.0%). IS1542 was inserted at position 3925 in the orf2-vanR intergenic region. The position of insertion site of IS1216V in the vanX-vanY intergenic region was variable in the Tertiary. All the isolates belonged to clonal complex 17 (CC17), associated with nosocomial infection worldwide. Sequence type (ST) 17 (38.9%) was predominant in Non-Tertiaries. There were 3 largest ST groups of ST18 (27.8%), ST192 (22.2%), and ST78 (22.2%) in the Tertiary. They are single or double locus variant of ST17. The Esp gene was found in 30 isolates (83.3%) from Non-Tertiaries and 12 isolates (66.7%) from the Tertiary (P > 0.05). The dendrogram created using rep-PCR results showed no genetic relatedness between the VREF isolates. These results suggest horizontal transmission of the vanA gene may have occurred among genetically diverse strains of E. faecium between Tertiaries and Non-Tertiaries in Korea.","반코마이신 내성 장알균(vancomycin resistant enterococci, VRE)은 중요 원내 감염균으로서 초기 대형 병원을 중심으로 발생, 최근에는 중소병원까지 토착화의 양상을 보이고 있다. 그러나 지금까지 VRE에 관한 대부분의 연구는 대형 병원에서 분리된 균주를 대상으로 한 것이므로 본 연구에서는 국내의 1, 2차 의료기관에서 분리된 VRE의 항균제 내성 양상, 분자생물학적 특성을 3차 의료기관에서 분리된 VRE의 결과와 비교하여 유전적 관련성, VRE 내성전이 기전 및 역학적 변동을 알아보고자 하였다. 2010년 10월부터 2011년 4월까지 일개의 3차 대학병원(1,087 병상)에서 분리된 반코마이신 내성 Enterococcus faecium (VREF) 18균주와 국내 20개 1, 2차 의료기관(0-544 병상)에서 분리된 VREF 36균주를 대상으로 항균제 최소억제농도(minimum inhibitory concentration, MIC), 반코마이신 내성 유전자형 검사, Tn1546 구조분석, multilocus sequence typing (MLST), 병독성 인자(esp) 검색, repetitive extragenic palindromic PCR (rep-PCR), 및 dendrogram 분석을 시행하였다. 54 개 VREF 균주 모두 vanA 내성 유전자형이었으며 항균제 MIC 검사결과 1, 2차 의료기관은 15 주(41.7%)가 VanB 내성 표현형을 보인 반면 3차에서는 13주(72.2%)가 VanB 내성 표현형을 보였다(P < 0.05). Tn1546 구조분석 결과 1, 2, 3차 의료기관에서 분리된 모든 균주에서 삽입서열(insertion sequence, IS)인 IS1542, IS1216V의 삽입이 관찰되었다. IS1542는 orf2-vanR intergenic region의 #3925 위치에서 삽입되었으나, IS1216V는 1, 2차에 비해 3차 의료기관은 vanX-vanY intergenic region의 다양한 위치에서 삽입되었다. IS 삽입과 동반된 유전자 결실로 변화된 Tn1546구조를 크게 I, II, III형으로 분류한 결과 1, 2차 의료기관은 Tn1546좌측 말단이 결실된 II형이(80.6%), 3차는 좌 우측 말단의 길이가 짧아진 III형(50.0%)이 우세하였다. MLST 분석 결과 54균주 모두 전세계적으로 병원감염과 연관되어 있다고 알려진clonal complex 17 (CC17)군에 속하며 1, 2차 의료기관에서는 sequence type (ST) 17이 14주(38.9%)로 가장 많았으나, 3차에서는 ST17의 double locus variant 인 ST18 5주(27.8%), ST192 4주(22.2%)와 single locus variant인 ST78 4주(22.2%)가 비교적 고르게 분포하였다. Esp 양성률은 1, 2차 의료기관 분리주에서 83.3%, 3차는 66.7%를 보이며 두 그룹간에 유의한 차이가 없었다(P > 0.05). Rep-PCR 시행 후 dendrogram을 확인한 결과 1, 2, 3차 의료기관에서 분리된 균주 사이에 유전적 연관성은 없었다. 본 연구결과 1, 2, 3차 의료기관의 VREF 균주는 유전적 연관성은 없었으나 반코마이신 내성 유전자의 동일한 유형을 공유하고 있어 국내 1, 2차 의료기관의 VRE전파는 균주의 수직전이(단클론성 확산)가 아니며, 초기에 3차 의료기관을 중심으로 유행하였던 VRE가 내성 유전자를 수평전이 시키는 방식으로 1, 2차 의료기관으로 전파된 것임을 알 수 있었다.","I. 서론 1 Ⅱ. 연구대상 및 방법 4 A. 연구대상 4 B. 방법 5 1. 항균제 최소억제농도(minimum inhibitory concentration, MIC) 5 2. 반코마이신 내성 유전자형 검사 6 3. Tn1546 구조분석 8 4. Multilocus sequence typing (MLST) 10 5. 병독성 인자(esp) 검색 12 6. 유전적 연관성 조사를 위한 rep-PCR 분석 13 Ⅲ. 결과 14 A. 항균제 최소억제농도(minimum inhibitory concentration, MIC) 14 B. 반코마이신 내성 유전자형 검사 15 C. Tn1546 구조분석 15 D. Multilocus sequence typing (MLST) 18 E. 병독성 인자(esp) 검색 21 F. 유전적 연관성 조사를 위한 rep-PCR 분석 21 Ⅳ. 고찰 23 Ⅴ. 결론 30 참고문헌 32 ABSTRACT 41","Doctor"]},{"key":"dc:title","label":"Title","values":["Molecular Characteristics and Dissemination Mechanism of Vancomycin-Resistant Enterococci: A Tertiary vs. Non-Tertiary Health Care Hospitals","국내 1, 2차 및 일개 3차 의료기관에서 분리된 반코마이신 내성 장알균의 분자생물학적 특성 비교를 통한 전파양식 규명"]}]}],"canonical_facts":{"dc:contributor":["대학원 의학과","201024451","정, 민권"],"dc:creator":["정, 민권"],"dc:date":["2012-11-06T01:30:31Z","2012"],"dc:description":["Vancomycin-resistant enterococci (VRE) have been endemic in Korea as a nosocomial pathogen. The aim of this study was to examine genetic relatedness and dissemination mechanism by comparative analysis of the antimicrobial and biomolecular characteristics of VRE isolates from tertiary and non-tertiary health care hospitals in Korea. We studied a total of 54 clinical vancocmycin-resistant Enterococcus faecium (VREF) isolates: 18 isolates collected from a tertiary health care hospital (Tertiary) (1,087 beds), and 36 isolates from 20 non-tertiary health care hospitals (Non-Tertiaries) (0-544 beds) in diverse geographical areas of Korea from October 2010 to April 2011. The mimimum inhibitory concentration (MIC)s of vancomycin and teicoplanin, multiplex PCR for resistance genotype, structural analysis of Tn1546, multilocus sequence typing (MLST), virulence factor (esp), and dendrogram of repetitive extragenic palindromic PCR (rep-PCR) were analyzed in all VREF isolates. All the isolates harboured the vanA gene. 15 isolates (41.7%) from Non-Tertiaries and 13 isolates (72.2%) from the Tertiary showed VanB phenotype (P < 0.05). All isolates were divided into 3 main types according to the distribution of IS elements (IS1542 and IS1216V) integrated into Tn1546. The major type of isolates from the Non-Tertiaries was type II (80.6%). Type III was the most prevalent among the isolates from the Tertiary (50.0%). IS1542 was inserted at position 3925 in the orf2-vanR intergenic region. The position of insertion site of IS1216V in the vanX-vanY intergenic region was variable in the Tertiary. All the isolates belonged to clonal complex 17 (CC17), associated with nosocomial infection worldwide. Sequence type (ST) 17 (38.9%) was predominant in Non-Tertiaries. There were 3 largest ST groups of ST18 (27.8%), ST192 (22.2%), and ST78 (22.2%) in the Tertiary. They are single or double locus variant of ST17. The Esp gene was found in 30 isolates (83.3%) from Non-Tertiaries and 12 isolates (66.7%) from the Tertiary (P > 0.05). The dendrogram created using rep-PCR results showed no genetic relatedness between the VREF isolates. These results suggest horizontal transmission of the vanA gene may have occurred among genetically diverse strains of E. faecium between Tertiaries and Non-Tertiaries in Korea.","반코마이신 내성 장알균(vancomycin resistant enterococci, VRE)은 중요 원내 감염균으로서 초기 대형 병원을 중심으로 발생, 최근에는 중소병원까지 토착화의 양상을 보이고 있다. 그러나 지금까지 VRE에 관한 대부분의 연구는 대형 병원에서 분리된 균주를 대상으로 한 것이므로 본 연구에서는 국내의 1, 2차 의료기관에서 분리된 VRE의 항균제 내성 양상, 분자생물학적 특성을 3차 의료기관에서 분리된 VRE의 결과와 비교하여 유전적 관련성, VRE 내성전이 기전 및 역학적 변동을 알아보고자 하였다. 2010년 10월부터 2011년 4월까지 일개의 3차 대학병원(1,087 병상)에서 분리된 반코마이신 내성 Enterococcus faecium (VREF) 18균주와 국내 20개 1, 2차 의료기관(0-544 병상)에서 분리된 VREF 36균주를 대상으로 항균제 최소억제농도(minimum inhibitory concentration, MIC), 반코마이신 내성 유전자형 검사, Tn1546 구조분석, multilocus sequence typing (MLST), 병독성 인자(esp) 검색, repetitive extragenic palindromic PCR (rep-PCR), 및 dendrogram 분석을 시행하였다. 54 개 VREF 균주 모두 vanA 내성 유전자형이었으며 항균제 MIC 검사결과 1, 2차 의료기관은 15 주(41.7%)가 VanB 내성 표현형을 보인 반면 3차에서는 13주(72.2%)가 VanB 내성 표현형을 보였다(P < 0.05). Tn1546 구조분석 결과 1, 2, 3차 의료기관에서 분리된 모든 균주에서 삽입서열(insertion sequence, IS)인 IS1542, IS1216V의 삽입이 관찰되었다. IS1542는 orf2-vanR intergenic region의 #3925 위치에서 삽입되었으나, IS1216V는 1, 2차에 비해 3차 의료기관은 vanX-vanY intergenic region의 다양한 위치에서 삽입되었다. IS 삽입과 동반된 유전자 결실로 변화된 Tn1546구조를 크게 I, II, III형으로 분류한 결과 1, 2차 의료기관은 Tn1546좌측 말단이 결실된 II형이(80.6%), 3차는 좌 우측 말단의 길이가 짧아진 III형(50.0%)이 우세하였다. MLST 분석 결과 54균주 모두 전세계적으로 병원감염과 연관되어 있다고 알려진clonal complex 17 (CC17)군에 속하며 1, 2차 의료기관에서는 sequence type (ST) 17이 14주(38.9%)로 가장 많았으나, 3차에서는 ST17의 double locus variant 인 ST18 5주(27.8%), ST192 4주(22.2%)와 single locus variant인 ST78 4주(22.2%)가 비교적 고르게 분포하였다. Esp 양성률은 1, 2차 의료기관 분리주에서 83.3%, 3차는 66.7%를 보이며 두 그룹간에 유의한 차이가 없었다(P > 0.05). Rep-PCR 시행 후 dendrogram을 확인한 결과 1, 2, 3차 의료기관에서 분리된 균주 사이에 유전적 연관성은 없었다. 본 연구결과 1, 2, 3차 의료기관의 VREF 균주는 유전적 연관성은 없었으나 반코마이신 내성 유전자의 동일한 유형을 공유하고 있어 국내 1, 2차 의료기관의 VRE전파는 균주의 수직전이(단클론성 확산)가 아니며, 초기에 3차 의료기관을 중심으로 유행하였던 VRE가 내성 유전자를 수평전이 시키는 방식으로 1, 2차 의료기관으로 전파된 것임을 알 수 있었다.","I. 서론 1 Ⅱ. 연구대상 및 방법 4 A. 연구대상 4 B. 방법 5 1. 항균제 최소억제농도(minimum inhibitory concentration, MIC) 5 2. 반코마이신 내성 유전자형 검사 6 3. Tn1546 구조분석 8 4. Multilocus sequence typing (MLST) 10 5. 병독성 인자(esp) 검색 12 6. 유전적 연관성 조사를 위한 rep-PCR 분석 13 Ⅲ. 결과 14 A. 항균제 최소억제농도(minimum inhibitory concentration, MIC) 14 B. 반코마이신 내성 유전자형 검사 15 C. Tn1546 구조분석 15 D. Multilocus sequence typing (MLST) 18 E. 병독성 인자(esp) 검색 21 F. 유전적 연관성 조사를 위한 rep-PCR 분석 21 Ⅳ. 고찰 23 Ⅴ. 결론 30 참고문헌 32 ABSTRACT 41","Doctor"],"dc:identifier":["http://repository.ajou.ac.kr/handle/201003/7643","http://dcoll.ajou.ac.kr:9080/dcollection/jsp/common/DcLoOrgPer.jsp?sItemId=000000012699","000000012699"],"dc:language":["ko"],"dc:subject":["Vancomycin-resistant Enterococcus faecium","VRE","vanA","Tn1546","Multilocus sequence typing","MLST","esp","Rep-PCR"],"dc:title":["Molecular Characteristics and Dissemination Mechanism of Vancomycin-Resistant Enterococci: A Tertiary vs. Non-Tertiary Health Care Hospitals","국내 1, 2차 및 일개 3차 의료기관에서 분리된 반코마이신 내성 장알균의 분자생물학적 특성 비교를 통한 전파양식 규명"],"dc:type":["Thesis","Theses"]},"updated_at":"2026-07-24T00:51:39Z"}