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새로운 말디토프 질량 분석 장비인 ASTA MicroIDSys의 임상 균주를 이용한 균종 동정 성능 평가

Evaluation of the Performance of ASTA MicroIDSys, a Novel Matrix-Assisted Laser Desorption/Ionization-Time of Flight Mass Spectrometry System, in Identification of Bacterial Clinical Isolates

이은정|김도균|정석훈|유창승
대한임상미생물학회 (Korean Society of Clinical Microbiology)|2020.09|Annals of Clinical Microbiology|제23권 제3호|pp. 1-14|DOI 10.5145/ACM.2020.23.3.3

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Bacterial identificationBruker BiotyperMicroIDSys

초록

배경: 최근 새로 출시된 말디토프 질량분석(matrix-assisted laser desorption/ionization-time of flight mass spectrometry, MALDI-TOF MS) 장비인 ASTA MicroIDSys (ASTA, Korea)는 기존의 MALDITOF MS 장비들과 균종 동정 결과의 일치율이 높은 것으로 보고된 바 있다. 본 연구는 임상미생물 검사실에 의뢰되었던 검체에서 배양된 균주 전수를 대상으로 ASTA MicroIDSys와 Bruker Biotyper (Bruker Daltonics, Germany)의 균종 동정 성능을 비교하였다. 또한 MALDI-TOF MS 에서 균종 구별이 잘 되지 않는다고 알려져 있는 균속들에 대한 추가적인 평가를 통해, ASTA MicroIDSys의 유용성과 한계를 평가하고자 하였다. 방법: 총 889주의 임상 분리주를 ASTA MicroIDSys와 Bruker Biotyper로 각각 균종을 동정하여 결과를 비교하였다. 동정된 균종 또는 균속이 일치하지 않는 경우 해당 균주의 16S rRNA 염기서열분석을 통해 균종을 확인하였고, Acinetobacter 균속과 Klebsiella 균속, Burkholderia cepacia complex 에 해당되는 모든 균주는 rpoB 와 hisA, recA 유전자의 염기서열 분석을 통해 균종을 확정하였다. 결과: ASTA MicroIDSys의 균속 및 균종 일치율은 장내세균에서 100%와 98.3%, 포도당 비발효그람음성 막대균에서 98.8%와 91.0%, 그람양성 알균에서 100%와 100%, 기타 균주에서 98.9% 와 98.9%였다. 균종 동정 결과가 일치하지 않았던 균주는 Acinetobacter 균속, Burkholderia 균속, Klebsiella 균속, Enterobacter 균속 등이었으며, 총 23건의 불일치 균종 중 17건(73.9%)은 데이터베이스에 포함되지 않은 균종에 기인한 것이었다. 임상미생물 검사실에서 5년간 보고되었던 총108,251건 중 기존 보고 결과와 일치할 것으로 예측되는 균종 동정 건수는 106,018건(97.9%)이었다. 결론: ASTA MicroIDSys는 환자 검체에서 분리되는 임상적으로 중요한 대부분의 균종을 정확하게 동정하였으며 Bruker Biotyper와도 높은 동정 일치율을 보여 임상미생물 검사실에서 유용하게사용할 수 있을 것으로 판단된다.

Abstract

Background: We evaluated the performance of ASTA MicroIDSys (ASTA, Korea) and Bruker Biotyper (Bruker Daltonics, Germany) systems in the identification of bacterial isolates from clinical microbiology laboratory specimens during the study period. In addition, species for which the identification accuracy using MALDI-TOF MS systems was previously reported to be poor were also identified by comparing the MS results with those obtained using molecular identification. Methods: A total of 889 non-duplicated clinical isolates were included in this study. The results of ASTA MicroIDSys were compared with those of Bruker Biotyper; 16S rRNA sequencing was performed for the species for which results obtained using the two systems did not match. The sequences of rpoB , hisA, and/or recA for the clinical isolates of Acinetobacter species, Klebsiella species, and Burkholderia cepacia complex were analyzed and used as reference identifications. Results: The concordance rates for bacterial identification using ASTA MicroIDSys and Bruker Biotyper were 100% at the genus level and 98.3% at the species level for isolates belonging to the order Enterobacterales. Similarly, the concordance rates at the genus and species levels were 98.8% and 91.0% for glucose non-fermenting bacilli, 100% and 100% for gram-positive cocci, and 98.9% and 98.9% for other isolates, respectively. ASTA MicroIDSys was expected to correctly identify 97.9% of the 108,251 isolates identified in our clinical microbiology laboratory over the past 5 years. Conclusion: ASTA MicroIDSys showed excellent performance in bacterial identification for most of the clinically relevant species. Further extension of the database could improve the identification accuracy of ASTA MicroIDSys.

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