환자의 혈액배양에서 분리된 균종과 항균제 감수성의 변화추이
Trends of the Species and Antimicrobial Susceptibility of Microorganisms Isolated from Blood Cultures of Patients
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배경：혈액배양은 패혈증의 원인균 동정에 중요한 검사방법이다. 혈액배양 결과의 분석 결과는 임상의에게 환자의 경험적 항생제 치료에 대한 매우 중요한 정보를 제공할 수 있다. 방법：2002부터 2005년까지의 조선대학교 병원 입원 및 외래환자에서 의뢰된 혈액배양에서 분리된 세균 균종과 항생제 감수성 결과를 분석하였다. BACTEC 9240 시스템에 배양한 후 자란 균종은 VitekⅡ 시스템으로 동정하였다. 항균제 감수성은 VitekⅡ 시스템 혹은 NCCLS 디스크 확산법으로 시험하였다. 결과：혈액배양 양성 환자수는 1,520 (18.5%)명이었다. 혈액배양에서 분리된 세균 중에서 호기성 및 통성혐기성 세균이 97.0%이고, 진균이 2.8%이었다. 흔히 분리된 균종을 빈도가 높은 것부터 나열하면 coagulase negative staphylococci, Escherichia coli, Staphylococcus aureus, Stenotrophomonas maltophilia, Serratia marcescens, Klebsiella pneumoniae순이었다. 조사 기간 중 ceftazidime과 imipenem에 내성을 보이는 Pseudomonas aeruginosa의 비율이 점차 증가 추세를 보였다. 결론：4년간의 혈액배양 결과 분석에서 흔한 피부 오염균인 coagulase negative staphylococci를 제외하면, 균혈증 환자에서 가장 많이 분리된 균은 E. coli이었다. 다양한 항생제에 내성인 세균의 증가에 대처하기 위해 감염관리 대책을 강화할 필요가 있는 것으로 보인다.
Abstract
Background: Blood culture is an important procedure for the determination of the etiologic agent of septicemia. Analysis of the blood culture results can provide clinicians with very important information for the empirical treatment of patients. Methods: In this study the blood cuture results at Chosun University Hospital during the years 2002 to 2005 were analysed to determine the species and antimicrobial susceptibility of the isolates. Blood culture bottles were incubated in BACTEC 9240 blood culture system; the isolates were identified by VitekⅡ, and antimicrobial susceptibility was tested by VitekⅡ system or the NCCLS disk diffusion method. Results: Positive blood cultures were obtained from 1,520 (18.5%) patients. Among the microorganisms isolated from blood culture, 97.0% were aerobic and facultative anaerobic bacteria and 2.8% were fungi. Frequently isolated organisms in decreasing order were coagulase-negative staphylococci (CNS), Escherichia coli, Staphylococus aureus, Stenotrophomonas maltophilia, Serratia marcescens, and Klebsiella pneumoniae. The proportion of Pseudomonas aeruginosa isolates resistant to ceftazidime and imipenem was increased during the study period. Conclusion: E. coli was the most frequent etiologic agent of bacteremia except CNS, common contaminants of skin, at Chosun University Hospital. It seems to be necessary to enhance infection control measures to cope with an increasing number of the resistant bacteria to various antibiotics.
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