개정된 Penicillin Breakpoints (CLSI M100-S18)에 따른 폐렴알균의 Penicillin 감수성률 변화
Impact of Revised Penicillin Breakpoints for Streptococcus pneumoniae (CLSI M100-S18) on the Penicillin Susceptibility Rate
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배경: 2008년 1월에 CLSI (Clinical and Laboratory Standards Institute)는 폐렴알균에 대한 penicillin breakpoints를 임상양상과 penicillin 투여 경로에 따라 다르게 개정하였다. 이에 본 연구에서는 혈액에서 분리된 폐렴알균을 대상으로 하여 penicillin breakpoints 변경에 의한 penicillin 감수성률 변화를 알아보고자 하였다. 방법: 2003년 1월부터 2008년 12월까지 한 대학병원 환자의 혈액으로부터 분리된 폐렴알균 156 균주를 대상으로 하였다. 반복 분리된 균주는 첫 번째 분리주만 포함하였으며 penicillin, cefotaxime 감수성 검사는 E-test (AB Biodisk, Solna,Sweden)로 시행하였다. Penicillin 감수성 결과는 2008년 CLSI 개정 전과 후로 비교 분석하였는데, 대상균주가 혈액으로부터 분리된 균이었으므로 개정 후는 비수막염, penicillin 비경구 투약 시를 기준으로 하였다. 결과: 2008년 CLSI 개정 전 기준으로는 총 156 폐렴알균 중 penicillin 감수성 66균주(42.3%), 중간 내성 66균주(42.3%),내성 24균주(15.4%)인 반면 개정 이후 비수막염, penicillin 비경구 투약 시를 기준으로 하면 penicillin 감수성 137균주(87.8%), 중간 내성 15균주(9.6%), 내성 4균주(2.6%)였다. 결론: 2008년 CLSI의 임상양상 및 penicillin 투약경로에 따른 penicillin breakpoints 변경에 의해 혈액에서 분리된 폐렴알균의 penicillin 감수성률이 크게 증가하였다. 이는 수막염을 제외한 침습적 폐렴알균 감염 치료에 penicillin을 좀 더 적극적으로 사용할 수 있는 근거가 되며, 상대적으로 광범위 항균제의 사용은 제한하는 효과를 가져올 수 있을 것으로 기대된다. [대한임상미생물학회지 2010;13:68-72]
Abstract
Background: In January 2008, the Clinical and Laboratory Standards Institute (CLSI) published revised penicillin breakpoints for Streptococcus pneumoniae according to clinical presentation and the route of penicillin administration. The aim of this study was to evaluate the impacts of the new penicillin breakpoints on the susceptibility rates of S. pneumoniae isolated from blood. Methods: A total of 156 non-duplicated S. pneumoniae strains recovered from blood of hospitalized patients were collected between January 2003 and December 2008. Penicillin and cefotaxime susceptibility tests were performed using an E-test (AB Biodisk, Solna, Sweden). Results of the penicillin susceptibility tests were analyzed using the former and new CLSI guidelines. Results: Of the 156 S. pneumoniae strains isolated from blood, penicillin susceptibility under the former CLSI guidelines resulted in 42.3% susceptible, 42.3%intermediate, and 15.4% resistant states. According to the new CLSI guidelines (nonmeningitis, parenteral),87.8% of isolates were susceptible, 9.6% were intermediate, and 2.6% were resistant to penicillin. Conclusion: When the new CLSI guidelines are applied,the penicillin susceptibility rate of S. pneumoniae strains isolated from blood is considerably increased. This suggests that penicillin should still be useful for the treatment of nonmeningeal pneumococcal infections and that the use of broad-spectrum antimicrobials should not replace this treatment. (Korean J Clin Microbiol 2010;13:68-72)
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