체액, 복막액 및 창상/농양 검체에서 MacConkey 배지 및 Colistin-Nalidixic Acid Blood Agar의 유용성 평가
Evaluation of the Usefulness of MacConkey Agar and Colistin-Nalidixic Acid Blood Agar for Body Fluids, Peritoneal Fluid, and Wound/Abscess Specimens
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배경: 체액(혈액, 뇌척수액, 요, 및 복막액 제외), 복막액, 및 창상/농양 검체의 배양에 대한 표준 배양법의 권장과는 달리 국내에서는 Columbia colistin-nalidixic acid blood agar (CNA)배지가 거의 사용되지 않고 있으며, 대부분 그람 염색과 배양이 동시에 시행되므로 권장 사항을 따르기 어려운 면이 있다. 본 연구에서는 이들 검체에서 MacConkey 배지(MAC) 및 Columbia colistin-nalidixic acid blood agar (CNA)의 유용성을 평가하였다. 방법: 총 1,508 검체[복막액 144 검체, 체액 241검체(담즙액 19 검체, 관절강액 70 검체, 심장낭액 6 검체, 흉수액 104 검체, 및 기타 체액 42 검체) 및 창상/농양 부위 1,123 검체]를 대상으로 기본배지(혈액한천배지, 초콜릿배지 혹은 Staphylococcus aureus가 획선된 혈액한천배지), MAC 및 CNA를 각각 추가하였을 때의 균 동정결과를 비교하였다. 결과: 전체 1,508 검체 중 기본 배지만을 사용하면 588검체에서 885균주가 분리되었으며 MAC을 추가하면 24검체에서 27균주가, CNA를 추가하면 112검체에서 128균주가 더 분리되었다. 기본 배지 사용과 비교하면, MAC을 추가함으로써 복막액에서는 233.3%, 체액에서는 38.5%, 창상에서는 4.5%의 그람음성균이 추가 동정되었다. CNA를 추가하면 기본 배지에 비해 복막액, 체액, 창상/농양 검체에서 그람양성균 및 진균이 각각 106.7%, 45.0%, 및 20.7% 추가 동정되었다. MAC에서만 자란 그람음성균주는 주로 장내세균(77.0%)이었으며, CNA에서만 분리되는 균주로는 S. aureus가 가장 많았고(21.1%), coagulase-negative staphylococcus (20.3%), Enterococcus spp. (16.4%), Streptococcus spp. (10.2%)순이었고 진균도 16.4%였다. 결론: 복막액 및 체액 검체에 대해서는 MAC와 CNA를 추가로 사용하는 것이, 창상/농양 검체는 CNA를 우선적으로 추가하는 것이 효과적일 것으로 생각된다. [Ann Clin Microbiol 2015;18:1-6]
Abstract
Background: Most clinical microbiology laboratories in Korea have difficulty in following the recommendations of the clinical procedure handbook for culture of body fluid and wound/abscess specimens. We evaluated the usefulness of MacConkey (MAC) and colistin-nalidixic acid blood agar (CNA) for the isolation of pathogens from these specimens. Methods: A total of 1,508 clinical specimens [144 peritoneal fluid, 241 body fluids (19 bile, 70 joint fluid, 6 pericardial fluid, 104 pleural fluid, and other fluids in 42 cases) and 1,123 wound/abscess] were inoculated onto basic media [Blood agar plate (BAP), chocolate agar or BAP with streaking of Staphylococcus aureus] and simultaneously inoculated onto MAC and CNA. The pathogens isolated by basic media and by additional use of MAC and/or CNA were compared. Results: With basic media, 885 isolates from 588 specimens were detected, and by additional use of MAC and CNA, an additional 27 isolates from 24 specimens and an additional 128 isolates from 112 specimens were isolated, respectively. Compared to the basic media, by adding MAC, an additional 233.3%, 38.5% and 4.5% of gram-negative bacteria were isolated from peritoneal fluids, body fluid and wound/abscess, respectively, and by adding CNA, an additional 106.7%, 45.0%, and 20.7% of gram-positive bacteria/yeast were isolated, respectively. The isolates detected by additional use of MAC were mainly Enterobacteriaceae (77.0%), and those detected by CNA were S. aureus (21.1%), Coagulase-negative Staphylococcus spp. (20.3%), Enterococcus spp. (16.4%), Streptococcus spp. (10.2%) and yeasts (16.4%). Conclusion: For peritoneal fluid and body fluid specimens, additional use of MAC plus CNA seems necessary for detection of pathogens. For wound/abscess, additional use of CNA will be cost effective. (Ann Clin Microbiol 2015;18:-6)
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