최근 20년 동안 단일 3차 의료기관의 칸디다혈증 환자에서 분리된 Candida 균종별 분리 빈도와 항진균제 내성률의 변화 추이
Trend of Prevalence and Antifungal Drug Resistance of Candida Species Isolated from Candidemia Patients at a Tertiary Care Hospital During Recent Two Decades
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배경: 칸디다혈증은 전세계적으로 고위험군 증가에 따라 발생이 증가하고 있어 임상적으로 더욱 중요해지고 있다. 이번 연구를 통해 칸디다혈증 환자에서 분리되는 칸디다 균종별 분리 빈도와 항진균제 내성률의 변화를 조사하였다. 방법: 1997년부터 2016년까지 국내 단일 3차 의료기관의 혈액배양에서 분리된 1,120 칸디다 균주를 대상으로 배양 연도, 성별, 나이, 진료과에 따라 분석하였다. 결과: 전체 기간 중 칸디다혈증 환자의 수는 1997년의 14명에서 2016년에는 84명으로 증가하였다. 20년 동안 칸디다의 균종별 분리 빈도는 Candida albicans 40.8%, Candida parapsilosis 24.1%, Candida tropicalis 13.2%와 Candida glabrata 12.8%의 순이었다. C. glabrata는 다른 균종에 비해 여성(45.5%)에서 상대적으로 높은 비율로 분리되었다. 연령별로 칸디다 균종이 많이 분리되는 연령군은 40세-89세군이었고 C. albicans는 신생아(66.7%), C. parapsilosis는 1-9세(41.7%), C. glabrata는 60세 이상(13.3%-20.0%)에서 상대적으로 흔히 분리되었다. 비수술과에서는 C. albicans, C. glabrata, C. haemulonii가 많이 분리되었고 수술과에서는 C. parapsilosis가 흔히 분리되었다. 항진균제 감수성 검사에서 최근 들어 azole 계열에 내성을 나타내는 C. albicans와 C. glabrata가 증가하는 경향을 보였다. 결론: 이번 연구를 통해 혈액에서 분리되는 칸디다의 균종별 분리 빈도는 연령, 성별과 진료과목에 따라 다르며 시기 변화에 따라 균종별 분리 빈도가 변화하는 것을 확인할 수 있었다. 항진균제에 대한 내성 양상 또한 변화하고 있어 이에 대한 지속적인 감시와 적합한 항진균제 선택이 요구된다. [Ann Clin Microbiol 2017;20:53-62]
Abstract
Background: Candidemia has increased with an increasing number of people in the high risk group and so has become more important. This study was conducted to investigate the isolation rate of Candida species from candidemia patients and the change in rate of antifungal resistance. Methods: At a single tertiary care hospital, 1,120 blood cultures positive for Candida species from 1997 to 2016 were investigated according to date of culture, gender, age, and hospital department. Results: During the investigation period, the number of candidemia patients increased from 14 in 1997 to 84 in 2016. The most common organism identified during the two decades was Candida albicans (40.8%), followed by Candida parapsilosis (24.1%), Candida tropicalis (13.2%), and Candida glabrata (12.8%). C. glabrata was relatively common in females (45.5%) compared to males. The age group 40-89 years was more frequently infected than other age groups, and the most frequent isolates according to age group were C. albicans in neonate (66.7%), C. parapsilosis in 1-9-year-olds (41.7%), and C. glabrata in those aged ≥60 years (range; 13.3%-20.0%). According to the visited departments, C. albicans, C. glabrata, and Candida haemulonii were more common in medical departments, while C. parapsilosis was more common in surgical departments. In the antifungal susceptibility test, a rising trend of azole resistance among C. albicans and C. glabrata was observed in recent years. Conclusion: In this study, it was confirmed that the isolation rate of Candida species in blood is different by age, gender, and hospital department, and the distribution of isolated Candida species changed over time. The resistance patterns of antifungal agents are also changing, and continuous monitoring and proper selection of antifungal agents are necessary. (Ann Clin Microbiol 2017;20:-62)
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