비강내 메티실린 내성 황색포도알균 검출 검사인 BD GeneOhm MRSA Real-time PCR Assay 평가
Evaluation of the BD GeneOhm MRSA Real-time PCR Assay for Detection of Nasal Colonization by MRSA
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배경: 병원감염의 주요 원인균인 메티실린 내성 황색 포도알균(methicillin-resistant Staphylococcus aureus, MRSA) 능동감시는 MRSA 전파를 막기 위해 중요하다. 최근 비강도말검체에서 직접 MRSA 유무를 검사하여 검사당일 결과보고가 가능한 BD GeneOhm MRSA real-time PCR assay (Becton Dickinson Diagnostics, San Diego, USA; GeneOhm MRSA PCR)가 소개되었다. 이에 저자들은 MRSA 능동감시에 있어서 GeneOhm MRSA PCR 검사가 임상적으로 유용한지를 평가하기 위해 PCR 결과와 배양 결과를 비교하였다. 방법: 연구 기간은 6개월이었으며, 중환자실 환자의 입원 당시 및 입원기간 내 일주일에 한 번씩 면봉으로 채취한 비강도 말검체 371예를 대상으로 하였다. 검체 배양 후 황색포도알균이 의심되는 경우는 BD Phoenix Automated Microbiology System (Becton Dickinson Diagnostic Systems, Sparks, USA)으로 MRSA임을 확인하였다. 제조사의 지침에 따라 GeneOhm MRSA PCR을 시행하였다. GeneOhm MRSA PCR 결과와 배양 결과가 불일치할 때는 증균 배양 결과를 확인하였다. 결과: GeneOhm MRSA PCR과 최종배양 결과의 차이를 보이는 예는 34예로, GeneOhm MRSA PCR 결과와 최종배양 결과의 일치도는 90.7%였다. 배양과 비교한 민감도는 96.8%, 특이도는 86.3%였고, 양성예측률은 83.9%, 음성예측률은 97.3%였다. 결론: GeneOhm MRSA PCR 검사는 검사소요시간이 2시간으로 짧고, 97.3%의 높은 음성예측률을 보여 MRSA를 보균하지 않은 환자를 빠르게 찾아내는 것이 가능하였다. 그러나, 양성예측률이 높지 않으므로 양성예는 증균배양을 이용하여 확인검사를 시행한다면 GeneOhm MRSA PCR을 MRSA 감시배양에 유용하게 이용할 수 있을 것으로 생각된다.
Abstract
Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a major nasocomial pathogen. The active surveillance of MRSA is essential to limit its transmission. The BD GeneOhm MRSA real-time PCR assay (Becton Dickinson Diagnostics, San Diego, USA) has been recently developed and used for same-day MRSA detection directly from nasal swab specimens. The authors of the present study compared GeneOhm MRSA PCR with culture methods to evaluate its diagnostic performance for MRSA active surveillance. Methods: The present study was conducted on patients admitted to the ICU for six months. A total of 371 nasal swab specimens were obtained from patients at admission day and at the seven-day follow-up. The swab was streaked onto culture media, and presumptive S. aureus colonies were confirmed as MRSA using the BD Phoenix automated microbiology system (Becton Dickinson Diagnostic Systems, Sparks, USA). In addition, GeneOhm MRSA PCR was performed. For discrepant results between Gene-Ohm MRSA PCR and culture, the enrichment broth culture method was performed. Results: There were 34 samples with discrepant results between the GeneOhm MRSA PCR and culture. The overall agreement was 90.7%. For the detection of MRSA, the GeneOhm MRSA PCR was 96.8% sensitive and 86.3% specific, with positive and negative predictive values of 83.9% and 97.3%,respectively. Conclusion: Identification of MRSA-colonized patients was achieved in as little as two hours, and the high negative predictive value of GeneOhm MRSA PCR suggests that the assay is a rapid method for the identification of persons who are not colonized with MRSA. However, due to the low positive predictive value, GeneOhm MRSA PCR combined with enrichment culture in cases of positive GeneOhm MRSA PCR is potentially useful for active MRSA surveillance activities.
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