항진균제 감수성 검사의 최신지견: 검사법과 임상적 이용
Current Status of Antifungal Susceptibility Testing: Methods and Clinical Application
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초록
지난 20년간 진균감염의 빈도가 증가되고 새로운 항진균제가 개발됨에 따라 효모균과 사상형 진균의 항진균제 감수성 검사를 위한 CLSI (Clinical and Laboratory Standards Institute) 표준법이 개발되고 정립되었다. 또한 검사실에서 일상적으 로 사용이 가능한 검사법인 Etest, 디스크 확산법 혹은 CLSI 액체배지 검사법을 변형한 새로운 방법 등도 소개되어 평가 되고 있다. 항진균제 감수성 검사는 현재 특정 병원이나 지역에서 분리되는 진균의 항진균제 감수성 양상을 알아보는 역학적 검사에 사용되며, 새로 개발된 항균제의 각종 진균에 대한 항진균 활성을 알아보고, 또 항진균제 치료의 임상적 결과를 예견하기 위한 일상적 검사로 사용되고 있다. 항진균제 감수성 검사는 amphotericin B 내성 검출, 사상형 진균의 임상적 결과와의 연관성 확립 및 항진균제 치료의 지침으로서 유용성 확대 등 아직도 해결해야 할 문제점이 많으나 점차 검사법이 향상되고 항진균제 선택 범위가 넓어짐에 따라 적절한 항진균제를 선택하는 데 매우 의미 있는 역할을 할 것으 로 기대된다.
Abstract
During the past two decades, Clinical and Laboratory Standards Institute (CLSI) antifungal susceptibility testing methods for both yeasts and molds have been developed and established in response to increasing invasive fungal infections and the release of multiple new antifungal agents. In addition, other methods including Etest, the disk diffusion test, and some CLSI modification methods have been intensively studied. Antifungal susceptibility tests are now routinely used for local epidemiological surveys to determine the susceptibility patterns of clinical isolates of fungi, the degree of antifungal activity of newly developed antifungal agents, and to predict the clinical outcomes of antifungal therapy for patients with Candida infections. It is anticipated that in the near future, antifungal susceptibility tests that can detect amphotericin B resistance, that can be used to establish the minimum inhibitory concentration (MIC) breakpoints of molds, and that can provide increased clinical guidance for antifungal therapy, will be developed. This review focuses on the various methods used for antifungal susceptibility testing and the clinical utility of antifungal susceptibility testing.
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