Pediatric Infection and Vaccine

The Korean Society of Pediatric Infectious Diseases (대한소아감염학회)
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Molecular Epidemiology of Bacillus cereus in a Pediatric Cancer Center

소아 암 환자에서 발생한 Bacillus cereus 균혈증의 분자역학 분석에 관한 연구

  • Kim, Jong Min (Department of Pediatrics, Myongji Hospital, Seonam University College of Medicine) ;
  • Park, Ki-Sup (Center for Clinical Research, Samsung Biomedical Research Institute) ;
  • Lee, Byung-Kee (Department of Pediatrics, Good Gang-An Hospital) ;
  • Kim, Soo Jin (Center for Clinical Research, Samsung Biomedical Research Institute) ;
  • Kang, Ji-Man (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Yanghyun (Center for Clinical Research, Samsung Biomedical Research Institute) ;
  • Yoo, Keon Hee (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Sung, Ki Woong (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Koo, Hong Hoe (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Nam Yong (Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Yae-Jean (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 김종민 (서남대학교 의과대학 명지병원 소아청소년과) ;
  • 박기섭 (삼성생명과학연구소 임상의학연구센터) ;
  • 이병기 (좋은강안병원 소아청소년과) ;
  • 김수진 (삼성생명과학연구소 임상의학연구센터) ;
  • 강지만 (성균관대학교 의과대학 삼성서울병원 소아청소년과) ;
  • 김양현 (삼성생명과학연구소 임상의학연구센터) ;
  • 유건희 (성균관대학교 의과대학 삼성서울병원 소아청소년과) ;
  • 성기웅 (성균관대학교 의과대학 삼성서울병원 소아청소년과) ;
  • 구홍회 (성균관대학교 의과대학 삼성서울병원 소아청소년과) ;
  • 이남용 (성균관대학교 의과대학 삼성서울병원 진단검사의학과) ;
  • 김예진 (성균관대학교 의과대학 삼성서울병원 소아청소년과)
  • Received : 2016.04.26
  • Accepted : 2016.05.13
  • Published : 2016.12.25
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Abstract

Purpose: Bacillus cereus has been reported as the cause of nosocomial infections in cancer patients. In our pediatric cancer ward, a sudden rise in the number of patients with B. cereus bacteremia was observed in 2013 to 2014. This study was performed to investigate the molecular epidemiology of increased B. cereus bacteremia cases in our center. Methods: Pediatric cancer patients who developed B. cereus bacteremia were identified from January 2001 to June 2014. The B. cereus bacteremia in this study was defined as a case in which at least one B. cereus identified in blood cultures, regardless of true bacteremia. Available isolates were further tested by multilocus sequence typing (MLST) analysis. A retrospective chart review was performed. Results: Nineteen patients developed B. cereus bacteremia during the study period. However, in 2013, a sudden increase in the number of patients with B. cereus bacteremia was observed. In addition, three patients developed B. cereus bacteremia within 1 week in July and the other three patients within 1 week in October, respectively, during emergency room renovation. However, MLST analysis revealed different sequence types without consistent patterns. Before 2013, five tested isolates were ST18, ST26, ST177, and ST147-like type, and ST219-like type. Isolates from 2013 were ST18, ST73, ST90, ST427, ST784, ST34-like type, and ST130-like type. Conclusions: MLST analyses showed variable ST distribution of B. cereus isolates. Based on this study, there was no significant evidence suggesting a true outbreak caused by a single ST among patients who developed B. cereus bacteremia.

목적: Bacillus cereus 는 암환자들에서 기회감염을 일으킬 수 있다. 2013년에서 2014년 기간 동안 삼성서울병원 소아 암 병동에서 B. cereus 균혈증의 급격한 증가가 관찰되었다. 이에 증가된 B. cereus 균혈증에 대해 분자역학적 연구를 시행하였다. 방법: 2001년 1월부터 2014년 6월까지의 기간 동안 B. cereus 균혈증이 발생한 소아 암 환자들을 확인하였다. 이번 연구에서 B. cereus 균혈증은, 오염여부와는 상관없이, 혈액배양검사에서 적어도 한번 이상 B. cereus 가 확인된 경우로 정의하였다. 획득 가능한 균주들에 대해 multilocus sequence typing (MLST) 분석을 시행하였고, 후향적 챠트 리뷰를 실시하였다. 결과: 연구 기간 동안 총 19명의 B. cereus 균혈증 환자가 확인되었다. 그러나, 2013년도에는 B. cereus 균혈증 환자가 급격하게 증가하였다. 또한, 응급실 공사 중이던 2013년 7월의 1주, 2013년 10월의 한주 동안 각각 3명의 환자가 발생하였다. 그러나 MLST 분석상 일정한 패턴이 없는, 다양한 sequence types (STs)들로 확인되었다. 2013년 이전의 5개의 균주들의 ST는 ST18, ST26, ST177, ST147-like type, ST219-like type이었고, 2013년도의 균주들의 ST는 ST18, ST73, ST90, ST427, ST784, ST34-like type, ST130-like type으로 확인되었다. 고찰: MLST 분석상 B. cereus 균주들의 다양한 ST 분포가 확인되었다. 이번 연구에서 단일 ST의 B. cereus 에 의한 균혈증 발생의 가능성은 낮아보인다.

Keywords

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