Comparison of Anti-mycobacterial Drug Susceptibility Test Results by Institutes and Methods
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배경: 결핵 감수성 검사의 결과가 검사실간 혹은 사용 배지에 따라 얼마나 일치율이 높은 지를 파악하여 신뢰성 있는 감수성 검사 방법을 선택하는 지침으로 삼고자 하였다. 방법: 국내 A병원에서 2005년에 항결핵제 감수성 검사가 시행된 122개 균주를 이용하여, A병원의 Löwenstein Jensen (L-J) 배지를 이용한 절대농도법(방법 A-1), B기관의 L-J 배지를 이용한 절대농도법과 한천배지를 이용한 비율법(각각 방법 B-1 및 방법 B-2)으로 isoniazid와 rifampin을 포함한 9개 약제로 검사를 실시하였다. 상기 두 약제는 90%, 나머지 약제는 80%를 허용 가능 수준으로 하여 민감도와 특이도를 비교하였다. 또한, 퀴놀론계 약물 투여자에서 ofloxacin 감수성 결과와 환자의 치료 경과를 비교하였다. 결과: 방법 B-1은 모든 약제에 대해 허용 가능한 수준의 민감도와 특이도를 보였다. 방법 B-2는 rifampin과 cycloserine에 대해 불량한 특이도를 보였다. 방법 A-1은 isoniazid, streptomycin, p-aminosalicylic acid, ofloxacin에 대해 불량한 특이도를, prothionamide, cycloserine에 대해서는 불량한 민감도를 보였다. Ofloxacin 감수성 검사 결과와 치료 경과의 일치율은 방법 B-1, 방법 B-2, 방법 A-1이 각각 77%, 74%, 65%였다. 결론: 항결핵제에 대한 감수성 검사는 일부 약제에서 검사 기관 별 혹은 사용 배지 별로 상이한 결과를 보여서, 항결핵제 감수성 검사의 신뢰도를 높이기 위한 정도 관리 프로그램의 도입이 시급하다.
Abstract
Background: The purposes of the current study were to evaluate the concordant rates of anti-mycobacterial drug susceptibility test (DST) results in different solid media performed in different institutes, and to determine reliable susceptible testing methods. Methods: One hundred and twenty two Mycobacterium tuberculosis strains were isolated from patients in A Hospital in 2005. DSTs were performed by the absolute concentration method using Löwenstein Jensen medium in both A Hospital (method A-1) and B Institute (method B-1) and by the proportion method using Middlebrook 7H10 agar in B Institute (method B-2). Nine drugs were used including isoniazid and rifampin. Sensitivity and specificity of each method were estimated by using the acceptable standard of 90% for isoniazid and rifampin and 80% for other drugs. The therapeutic outcomes of quinolone-administered patients were evaluated according to ofloxacin susceptibility results. Results: Method B-1 showed sensitivity and specificity levels over the acceptable standard levels for all drugs. Method B-2 showed specificity lower than the acceptable levels for rifampin and cycloserine. Method A-1 showed specificity lower than the acceptable levels for isoniazid, streptomycin, p-aminosalicylic acid, and ofloxacin and sensitivity lower than the acceptable levels for prothionamide and cycloserine. The concordance rates of therapeutic outcomes with method B-1, method B-2, and method A-1 were 77%, 74%, and 65%, respectively. Conclusion: The drug susceptibility results for some drugs were discordant between the testing laboratories and media, requiring an urgent application of quality control programs to raise the reliability of anti- mycobacterial DST.
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