Microbacterium 에 의한 중심정맥관 연관 균혈증 1예: 16S rRNA 유전자 염기서열분석을 이용한 균 동정
Central Venous Catheter-Related Microbacterium Bacteremia Identified by 16S ribosomal RNA Gene Sequencing
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초록
저자들은 급성림프구성백혈병으로 진단받고, 관해 유도치료 및 일차 강화 치료시행 후 회복 중이던 14세 남아에서 Microbacterium에 의한 중심정맥관 연관 균혈증을 경험하였기에 보고하는 바이다. 내원 후 2일부터 62일까지 시행한 9차 례의 혈액배양에서 황색의 작은 집락을 형성하는 그람양성 막대균이 지속적으로 분리되었다. 이 균은 Vitek 2 (bioMerieux, USA)와 MicroScan WalkAway 96 system (Dade Behring, USA)에 의해 Micrococcus spp.로, API Coryne system (bioMerieux, France)에 의해 Rhodococcus spp. 및 Brevibacterium spp.로 동정된 반면, 16S rRNA 유전자 염기서열분석 결과, Microbacterium 균종과 99%의 일치율을 보였다. 전신적인 항생제 치료에도 불구하고 환아의 균혈증은 2개월간 지속되었 으나, 중심정맥관 연관 균혈증 치료를 위한 teicoplanin lock therapy 시행 후 혈액배양에서 더 이상 균이 자라지 않았다. 본 증례는 국내에서 중심정맥관 연관 Microbacterium 균혈증에 관한 첫 증례보고이다.
Abstract
We describe here a case of central venous catheter (CVC)-related bacteremia caused by Microbacterium species in a 14-year-old patient, who had received chemotherapy for acute lymphoblastic leukemia. All nine blood cultures obtained from admission day 2 to day 62 yielded the same yellow-pigmented coryneform rod. Both Vitek 2 (bioMerieux, USA) and MicroScan (Dade Behring, USA) identified the isolate as Micrococcus species, and the API Coryne (bioMerieux, France) identified the isolate as Rhodococcus or Brevibacterium species. However, the 16S rRNA gene sequence showed a 99% identity with Microbacterium species. The bacteremia was recurrent or persistent over 60 days despite alternate systemic antibiotic therapy, but blood culture became negative after an addition of teicoplanin lock therapy for eradicating CVC-related bacteremia. This represents the first report of CVC-related Microbacterium bacteremia cured by antibiotic lock therapy in Korea.
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