장기 운송 후 수송배지에 따른 임균 검출능 및 타 성 매개 병원균과의 동시 감염률 평가
The Evaluation of Recovery Rate of Neisseria gonorrhoeae in Two Bacterial Transport Swab Systems and Prevalence of Co-Infection after Delayed Transport
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배경: 임균 감염은 여전히 흔하며 항생제 내성균의 등장으로 치료가 점점 어려워 지고 있다. 임균 감염 및 항균제 내성을 극복하기 위해서는 균주의 분리 및 검체 운송에 따른 양성률 평가가 필요하다. 또한 성 매개 질환의 적절한 치료를 위해 중복감염 여부를 평가하여야 한다. 본 연구에서는 국내 의료기관에서 운송된 검체에서의 배양 양성률과 임균 감염이 확인된 환자의 동시 감염률을 평가하고자 하였다. 방법: 2010년 1월부터 2012년 11월까지 3개의 1차 의료기관에 내원한 임질 의심환자로부터 생식기 검체를 Transgrow 배지와 상품화된 BD 운송 배지를 이용하여 수집하여 배양하였고, 주요 성매개 원인균에 대한 다중 중합효소연쇄반응을 시행하였다. 결과: 배양과 PCR을 시행한 162개의 검체 중, 배양은 57개(35.2%), PCR은 146개(90.1%)에서 양성 소견을 얻을 수 있었다. 운송 배지에 따른 배양 양성률은 Transgrow 배지에서 29.9% (78/261), BD 운송배지에서 19.2% (50/261)였다. 다중 중합효소연쇄반응 결과에서는 C. trachomatis (15.8%), M. hominis (6.2%) 그리고 M. genitalium (3.4%) 순으로 N. gonorrhoeae와의 중복 감염이 많았다. 결론: 일반적인 운송 상황에서 임균 배양의 양성률은 운송 배지의 종류에 따라 19.2-29.9%로 임균 감염 환자의 70%에서는 분자 진단 등이 필요하다. 또한 임질에 감염된 환자에서는 중복 감염이 드물지 않아 정확한 검사에 의한 항균제 추가 처방이 필요할 수 있다. [Ann Clin Microbiol 2014;17:110-114]
Abstract
Background: Neisseria gonorrhoeae infection remains prevalent, and the emergence of antimicrobial resistance has made the treatment and control of gonorrhea more difficult. Therefore, it is important to compare isolation methods and transport media to overcome gonorrhea via epidemiologic understanding and to determine co-infection rates with other sexually transmitted diseases among primary-care hospitals. In this study, we determine the recovery rate of transferred specimens according to type of transport media and co-infection rate using PCR. Methods: Genital specimens were collected at three primary-care hospitals from January 2010 to November 2012 using transgrow media and commercial BD transport media. Culture and multiplex PCR were conducted to isolate N. gonorrhoeae. Results: Among 162 specimens, 57 (35.2%) isolates were recovered, and 146 (90.1%) specimens were positive for multiplex PCR. The recovery rate was 29.9% (78/261) using transgrow media and 19.2% (50/261) using BD transport media. The most common co-infected bacteria with N. gonorrhoeae was Chlamydia trachomatis (15.8%), followed by Mycoplasma hominis (6.2%) and M. genitalium (3.4%). Conclusion: Under general transport conditions, the rate of recovery of N. gonorrhoeae was as low as 19.2-29.9% depending on the type of transport media, suggesting that molecular diagnostic methods are required to detect the remaining 70% of gonorrhea-infected patients. Co-infection with other sexually transmitted diseases was not rare, and other tests for accurate additional antimicrobial regimens should also be considered. (Ann Clin Microbiol 2014; 17:-114)
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