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호흡기 검체에서의 비결핵 항산균 분리율

Prevalence and Species Spectrum of Pulmonary Nontuberculous Mycobacteria Isolates at a Tertiary Care Center

윤은정|정석훈|김건한|주영선|곽나은
대한임상미생물학회 (Korean Society of Clinical Microbiology)|2019.09|Annals of Clinical Microbiology|제22권 제3호|pp. 71-76|DOI https://doi.org/10.5145/ACM.2019.22.3.71

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Species identificationNon-tuberculosis mycobacteriaPulmonary specimen

초록

호흡기 검체에서의 비결핵 항산균 분리율1상지대학교 임상병리학과, 2바이오파크진단 주식회사, 3강남세브란스병원 진단검사의학과, 4연세대학교 의과대학 진단검사의학교실 및 세균내성연구소주영선1, 곽나은2, 김건한3, 윤은정4, 정석훈4 배경: 비결핵 항산균(nontuberculous mycobacteria, NTM)은 균종에 따라 치료 전략이 상이하므로 신속하고 정확한 균종의동정과 균종별 분리율에 대한 동향 파악이 필요하다. 본 연구에서는 호흡기 임상검체에서 분리한 NTM의 균종별 분리율을 조사하였다. 방법: 2018년 5월에서 11월까지 7개월간 서울 소재 814병상 규모 종합병원의 진단검사의학과로 배양검사가 의뢰된 항산균 감염 의심 환자의 객담 및 기관지세척액 1,209검체에서 균주를 분리배양하여 추출한 DNA를 대상으로 16S-23S rDNA internal transcribed spacer 및 rpoB 유전자를 증폭하여 분석한 염기서열 기반으로 균종을 동정하였다. 결과: 총 1,209검체의 배양검사 결과 분리된 483예 중 31.1% (n=150)는 결핵균이었고, 68.9% (n=333)는 NTM이었다. 이들NTM 중, 67.6% (225/333)가 Mycobacterium avium complex이었으며, M. avium 137예와 Mycobacterium intracellulare 88예로구성되어 있었다. NTM 중 9.0%는 Mycobacterium abscessus (30/333)였으며, M. abscessus subsp. abscessus (n=15)와 M. abscessus subsp. marsiellense (n=15)로 구성되어 있었다. 또한 Mycobacterium lentiflavum 13예(3.9%), Mycobacterium gordonae 12예(3.6%), Mycobacterium fortuitum 6예(1.8%) 및 Mycobacterium kansasii 6예(1.8%)가 확인되었다. 이밖에, Mycobacterium yongonense, Mycobacterium mucogenicum, Mycobacterium septicum, Mycobacterium colombiens, Mycobacterium asiaticum, Mycobacterium celatum 및 Mycobacterium chimaera 균주가 1-2예씩 확인되었다. 결론: NTM에 의한 폐질환은 항산균 감염 중 2/3으로 그 비율이 높아지고 있어 NTM 분리 균종과 분리빈도에 대한 지속적 관리와 감시가 필요하며, 특히 자연내성으로 치료에 어려움을 겪는 M. abscessus subsp. abscessus의 분리율이 5%에육박하는 바, 이에 대한 지속적 관찰이 요구된다. [Ann Clin Microbiol 2019;22:71-76]

Abstract

Background: Pulmonary infection with nontuberculous mycobacteria (NTM) is increasing in South Korea. Since treatment strategy differs by NTM species, accurate identification is necessary. In this study, using Mycobacterium pulmonary isolates recently recovered from a general hospital in Seoul, the prevalence of NTM isolates was investigated. Methods: A total of 483 Mycobacterium pulmonary strains isolated between May and November 2018 from an 814-bed general hospital in South Korea were analyzed. Bacterial species were identified based on nucleotide sequences of the 16S-23S rDNA internal transcribed spacer and the rpoB gene. Results: From a total of 1,209 pulmonary specimens from patients suspected to be infected with mycobacteria, 324 deduplicate strains were isolated, comprising 90 Mycobacterium tuberculosis and 229 NTM strains. Among the NTM isolates, 61.5% (n=144) were Mycobacterium avium complex (MAC), including 92 M. avium and 52 Mycobacterium intracellulare, while 8.1% (n=19) represented Mycobacterium abscessus, including 10 M. abscessus subsp. abscessus and 9 M. abscessus subsp. massiliense. In addition, 12 (5.1%) Mycobacterium lentiflavum, 12 (5.1%) Mycobacterium gordonae, 6 (2.6%) Mycobacterium kansasii, and 5 (2.1%) Mycobacterium fortuitum were identified. In addition, Mycobacterium mucogenicum (n=2), Mycobacterium septicum (n=1), Mycobacterium colombiens (n=1), Mycobacterium asiaticum (n=1), and Mycobacterium celatum (n=1) were identified. Conclusion: Among the recently recovered Mycobacterium pulmonary strains, more than half were identified as NTM, and MAC was the most prevalent NTM, followed by M. abcessuss. (Ann Clin Microbiol 2019;22:71-76)

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