국내 분리 칸디다균주에 대한 VITEK-2 항진균제 감수성 검사(AST-YS01)의 평가
Evaluation of VITEK-2 Antifungal Susceptibility Test (AST-YS01) for Candida Species Isolates in Korea
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배경: 최근 VITEK-2 시스템에서 항진균제 감수성 검사를 실시하는 제품인 AST-YS01 (bioMerieux, Hazelwood, MO, USA) 가 소개되었는데, 이는 자동화가 가능하고 분광광도계를 이용하여 MIC (minimum inhibitory concentrations) 판독을 실시 함으로써 주관적 오류를 최소화한 제품이다. 저자들은 국내에서 분리된 칸디다 균주를 대상으로 VITEK-2 항진균제 감 수성 검사를 실시하고 이 성적을 CLSI (The Clinical and Laboratory Standards Institute)법과 비교 평가하여 보았다. 방법: 최근 18개월간 국내 두 곳의 병원 혈액배양에서 분리된 칸디다 175주(C. albicans 64주, C. parapsilosis 50주, C. tropicalis 32주 및 C. glabrata 10주, C. guilliermondii 6주 및 그 외 13주)를 대상으로 하였다. 각 균주는 VITEK-2를 이용하 여 AST-YS01 항진균제 감수성 검사를 시행하고 동시에 CLSI M27법(액체배지 미량희석법)으로 amphotericin B, fluconazole, voriconazole에 대해 MIC (24시간 및 48시간 배양 후)를 검사하여 그 성적을 비교하였다. 결과: VITEK-2 시스템에서 175주의 감수성 결과는 11.75∼35.50시간(평균 16.3±4.8시간) 배양 후 판독되었다. VITEK-2에 의한 amphotericin B, fluconazole 및 voriconazole 성적의 24시간 CLSI법과의 일치율(2희석 배수 내)은 각각 98.3%, 90.9% 및 96.0%였고, 48시간 CLSI법과의 일치율은 각각 100%, 92.6% 및 94.9%였다. 24시간 및 48시간 CLSI법과 비교하여 fluconazole에 대한 감수성/내성의 범주오차는 각각 6.3% (major error 2.9%, minor error 3.4%) 및 6.3% (major error 2.3%, minor error 4.0%)였고, voriconazole에 대한 범주오차는 24시간 및 48시간 모두 1.7% (major error 1.1%, minor error 0.6%)였 다. Fluconazole과 voriconazole 모두 very major error는 없었다. 결론: VITEK-2 시스템을 이용한 자동화된 항진균제 감수성 검사는 신속하게 결과를 얻을 수 있으며 CLSI 표준방법과 일치율이 매우 높아 일반검사실에서 유용하게 사용될 수 있을 것으로 생각된다.
Abstract
Background: VITEK-2 yeast susceptibility test (ASTYS01; bioMerieux, Hazelwood, MO, USA) has recently been introduced as a fully automated commercial antifungal susceptibility test system that determines MIC (minimum inhibitory concentrations) endpoints spectrophotometrically, thereby eliminating subjective errors. We compared the VITEK-2 system with the CLSI (the Clinical and Laboratory Standards Institute) M27 method for susceptibility testing of Candida isolates from Korea. Methods: A total of 175 Candida bloodstream isolates were collected from two hospitals during a 18-month period. We compared the MIC results for amphotericin B, fluconazole and voriconazole obtained with the VITEK-2 system to those obtained by the CLSI M27 broth microdilution method after 24-hr and 48-hr incubation. Results: VITEK-2 system MIC endpoints for 175 isolates were determined after 11.75 to 35.50 hr of incubation (mean, 16.3±4.8 hr). The essential agreement (within 2 dilutions) between amphotericin B, fluconazole and voriconazole MICs obtained by the VITEK-2 system and CLSI method was 98.3%, 90.9% and 96.0%, respectively, at 24-hr incubation and 100%, 92.6% and 94.9%, at 48-hr incubation. The categorical discrepancy for fluconazole was 6.3% (major error, 2.9% and minor error, 3.4%) at 24-hr and 6.3% (major error, 2.3% and minor error, 4.0%) at 48-hr. The categorical discrepancy for voriconazole was 1.7% (major error, 1.1% and minor error, 0.6%) at both 24-hr and 48-hr. There were no very major errors for fluconazole and voriconazole. Conclusion: The VITEK-2 antifungal susceptibility test system appears to be rapid and highly correlative with the CLSI method, sugesting that this system can be effective for antifungal susceptibility testing for Candida species in the clinical laboratory.
참고문헌 (13)
- Shin JH, "Antifungal drug susceptibility", Hanyang Med Rev, 26, pp.79~85 (2006)
- Reference method for broth dilution antifungal susceptibility testing of yeasts: approved standard, Third ed, "Clinicaland Laboratory Standards Institute", Clinical and Laboratory Standards Institute, ~, pp.M27-A3 (2008)
- Murray PR, "Manual of Clinical Microbiology. 9th ed", pp.1972~1986 (2007), American Society for Microbiology
- Pfaller MA, "Antifungal susceptibility testing. New technology and clinical applications", Infect Dis Clin North Am, 15, pp.1227~1261 (2001)
- Pfaller MA, "Antifungal susceptibility testing methods", Current Drug Targets, 6, pp.929~943 (2005)
- Pfaller MA, "Multicenter comparison of the VITEK 2 yeast susceptibility test with the CLSI broth microdilution reference method for testing fluconazole against Candida spp", J Clin Microbiol, 45, pp.796~802 (2007)
- Pfaller MA, "Multicenter comparison of the VITEK2 antifungal susceptibility test with the CLSI broth microdilution reference method for testing amphotericin B, flucytosine, and voriconazole against Candida spp", J Clin Microbiol, 45, pp.3522~3528 (2007)
- 이진솔, "Species Distribution and Susceptibility to Azole Antifungals of Candida Bloodstream Isolates from Eight University Hospitals in Korea", Yonsei Medical Journal, 48(5), pp.779~786 (2007), 연세대학교의과대학
- Pfaller MA, "Correlation of MIC with outcome for Candida species tested against voriconazole: analysis and proposal for interpretive breakpoints", J Clin Microbiol, 44, pp.819~826 (2006)
- 박지영, "CLSI 액체배지 미량희석법, Etest 및 Minimum Fungicidal Concentration 검사에 의한 국내 혈액에서 분리된 효모균의 시험관 내 Amphotericin B 내성 성적", The Korean Journal of Laboratory Medicine, 28(5), pp.346~352 (2008), 대한진단검사의학회
- Antoniadou A, "Candidemia in a tertiary care cancer center: in vitro susceptibility and its association with outcome of initial antifungal therapy", Medicine (Baltimore), 82, pp.309~321 (2003)
- Food and Drug Administration, "Class II special controls guidance document: antimicrobial susceptibility test (AST) systems; guidance for industry and FDA" (2007), Food and Drug Administration
- Kim SH, "The relationship between antifungal usage and antifungal susceptibility in clinical isolates of Candida: a multicenter Korean study", Med Mycol, 47, pp.296~304 (2009)