한 대학병원에서 폐렴구균 소변항원검사 양성 결과의 분석
Investigation of Positive Streptococcus pneumonia Urinary Antigen Test Results in a Korean University Hospital
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
배경: 폐렴알균 소변 항원 검사(Streptococcus pneumoniae Urinary Antigen Test)는 지역사회 획득 폐렴의 가장 흔한 원인인폐렴알균 폐렴의 빠른 진단을 위해 소변 내 polysaccharide C를 검출하는 방법으로 개발되었다. 본 연구자들은 본 검사의양성 결과의 임상적 의의를 확인하기 위해, 지역사회 획득 폐렴이 의심되어 단일 대학병원의 응급실을 통해 방문해서시행된 폐렴알균 소변 항원 검사 결과를 후향적 연구를 통하여 평가하였다. 방법: 2007년에서 2008년까지 단일 대학병원의 응급실을 통해 입원한 1,143명의 폐렴 환자의 폐렴알균 소변 항원 검사결과 중 123건의 양성 결과를 본원의 검사정보시스템에서 추출하였다. 본 검사에서 양성을 보인 모든 환자들에 대해의무기록을 면밀히 조사하였다. 결과: 폐렴알균 소변 항원 검사에서 양성을 보인 123명의 폐렴 환자 중 24명의 환자들은 병원 획득성 폐렴으로 분류되었으며, 99명의 환자가 지역사회 획득 폐렴으로 추정되었다. 9.1%의 환자에서 객담 및 혈액 배양 검체에서 폐렴 알균이검출되었다. 23.2% 환자에서는 배양 검체에서 다른 세균성 폐렴 원인 미생물이 검출되어, 12.1% 환자에서는 요도 감염또는 오염으로 고려되는 미생물들이 검출되어, 35.3%의 양성결과들은 위양성으로 고려되었으며, 이러한 미생물들을 교차반응을 일으킬 수 있는 원인으로 분류하였다. 55.6% 환자에서는 배양 검사에서 음성결과를 보였으며, 이 중 일부는배양 검사가 음성인 폐렴알균 폐렴의 가능성을 시사하였다. 결론: 본 연구를 통해 지역사회 획득 폐렴의 가장 흔한 원인인 폐렴알균 폐렴의 빠른 진단을 위한 폐렴알균 소변 항원검사의 양성 결과들이 기존 미생물 배양검사법과 낮은 일치도를 보임이 확인되었다. 그러므로, 대학병원의 실제 임상상황에서 폐렴알균 소변 항원 검사의 양성 결과를 통한 원인균의 판정은 제한점이 있음이 시사된다. [대한임상미생물학회지 2010;13:14-18]
Abstract
Background: The Streptococcus pneumoniae urinary antigen test (SPUAT) (Binax Now, USA) was developed for detecting polysaccharide C in urine samples for rapid diagnosis of pneumococcal pneumonia, the most common cause of community-acquired pneumonia (CAP). To validate positive results of these tests,we retrospectively investigated all positive results obtained from the emergency room of a Korean university hospital among patients with suspected CAP. Methods: One hundred twenty-three positive SPUAT results were abstracted and analyzed from the authors'laboratory information system among the SPUAT results performed from 1,143 pneumonic patients admitted from the emergency room of a university hospital between 2007 and 2008. Medical records,including conventional microbiologic analysis results, were reviewed in detail for all positive test results. Results: Among 123 patients with the positive SPUAT results, 24 patients were excluded due to hospitalization history during the preceding month. Nine of 99 patients (9.1%) with suspected CAP had confirmed pneumococcal pneumonia upon conventional sputum or blood culture. Thirty-five positive results (35.4%) showed other microorganisms upon conventional methods, which might be due to possible cross-reactivity. Among those, 23 positive results were considered bacterial pneumonic agents, and 12 positive results were regarded as urinary tract infection strains or contaminating agents. Fifty-five positive SPUAT results (55.6%) showed negative conventional microbiologic growth, and some positive SPUAT results might be caused by true pneumococcal infection although without cultural evidence. Conclusion: Our retrospective study demonstrated that a positive SPUAT result typically does not agree well with conventional culture methods, suggesting that the value of a positive SPUAT result in etiology determination may be limited under practical conditions in a university hospital. (Korean J Clin Microbiol 2010;13:14-18)
참고문헌 (23)
- File TM, "Community-acquired pneumonia", Lancet, 362, pp.1991~2001 (2003)
- Mandell LA, "Infectious Diseases Society of America", American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults, 2007, pp.44(2), 27~72
- Aleva RM, "Dutch Thoracic Society. Guideline 'Diagnosis and treatment of community-acquired pneumonia' from the Dutch Thoracic Society", Ned Tijdschr Geneeskd, 149, pp.2501~2507 (2005)
- Mandell LA, "Infectious Diseases Society of America. Update of practice guidelines for the management of community-acquired pneumonia in immunocompetent adults", Clin Infect Dis, 37, pp.1405~1433 (2003)
- Fuse ET, "Evaluation of the usefulness of a rapid immunochromatographic membrane test to detect Streptococcus pneumoniae antigen in the early diagnosis of pneumococcal respiratory tract infections and the relationship to the severity of pneumonia", Nihon Kokyuki Gakkai Zasshi, 46, pp.10~18 (2008)
- Burel E, "Evaluation of a rapid immunochromatographic assay for detection of Streptococcus pneumoniae antigen in urine samples", Eur J Clin Microbiol Infect Dis, 20, pp.840~841 (2001)
- Dominguez J, "Detection of Streptococcus pneumoniae antigen by a rapid immunochromatographic assay in urine samples", Chest, 119, pp.243~249 (2001)
- Murdoch DR, "Evaluation of a rapid immunochromatographic test for detection of Streptococcus pneumoniae antigen in urine samples from adults with community-acquired pneumonia", J Clin Microbiol, 39, pp.3495~3498 (2001)
- Genne D, "Enhancing the etiologic diagnosis of community-acquired pneumonia in adults using the urinary antigen assay (Binax NOW)", Int J Infect Dis, 10, pp.124~128 (2006)
- Andreo F, "Persistence of Streptococcus pneumoniae urinary antigen excretion after pneumococcal pneumonia", Eur J Clin Microbiol Infect Dis, 28, pp.197~201 (2009)
- Smith MD, "Diagnosis of Streptococcus pneumoniae infections in adults with bacteremia and community-acquired pneumonia: clinical comparison of pneumococcal PCR and urinary antigen detection", J Clin Microbiol, 47, pp.1046~1049 (2009)
- Stralin K, "Comparison of two urinary antigen tests for establishment of pneumococcal etiology of adult community-acquired pneumonia", J Clin Microbiol, 42, pp.3620~3625 (2004)
- Charkaluk ML, "Assessment of a rapid urinary antigen detection by an immunochromatographic test for diagnosis of pneumococcal infection in children", Diagn Microbiol Infect Dis, 55, pp.89~94 (2006)
- Gutierrez F, "Evaluation of the immunochromatographic Binax NOW assay for detection of Streptococcus pneumoniae urinary antigen in a prospective study of community-acquired pneumonia in Spain", Clin Infect Dis, 36, pp.286~292 (2003)
- Ishida T, "A 3-year prospective study of a urinary antigen-detection test for Streptococcus pneumoniae in community-acquired pneumonia: utility and clinical impact on the reported etiology", J Infect Chemother, 10, pp.359~363 (2004)
- Marcos MA, "Rapid urinary antigen test for diagnosis of pneumococcal community-acquired pneumonia in adults", Eur Respir J, 21, pp.209~214 (2003)
- Murdoch DR, "The NOW S. pneumoniae urinary antigen test positivity rate 6 weeks after pneumonia onset and among patients with COPD", Clin Infect Dis, 37, pp.153~154 (2003)
- Farina C, "Urinary detection of Streptococcus pneumoniae antigen for diagnosis of pneumonia", New Microbiol, 25, pp.259~263 (2002)
- Honore S, "Contribution of urinary pneumococcal antigen detection combined with the research of legionella antigen for diagnosis of pneumonia in hospitalized patients", Pathol Biol (Paris), 52, pp.429~433 (2004)
- Payeras Cifre A, "Usefulness of a new fast technique for detection of pneumococcal antigen in the diagnosis of community pneumonia", Rev Clin Esp, 203, pp.521~525 (2003)
- Watanuki Y, "Usefulness of urinary antigen and sputum Gram stain for rapid diagnosis of pneumococcal respiratory infections", Kansensho gaku Zasshi, 79, pp.13~19 (2005)
- Tzeng DH, "Diagnostic value of the Binax NOW assay for identifying a pneumococcal etiology in patients with respiratory tract infection", J Microbiol Immunol Infect, 39, pp.39~44 (2006)
- Garcia-Suarez MD, "Diagnostic detection of Streptococcus pneumoniae PpmA in urine", Clin Microbiol Infect, 15, pp.443~453 (2009)