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Streptococcus bovis 균혈증 환자의 선행질환과 항균제 감수성

Underlying Diseases Associated with Streptococcus bovis Bacteremia and Antimicrobial Susceptibility of the Organism

황규열|윤갑준|어영|김효열|권오건
대한임상미생물학회 (Korean Society of Clinical Microbiology)|2006.04|Annals of Clinical Microbiology|제9권 제1호|pp. 36-41

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초록

배경：국내에서는 Streptococcus bovis 생물형과 임상적 감염병, 선행 악성종양과의 연관성 및 S.bovis의 항균제 감수성에 대한 자료가 거의 없는 실정이다. 이에 본 조사에서는 혈액에서 분리되는 S.bovis 균혈증 환자의 임상적 특징과 항균제 감수성 양상을 분석하였다. 방법：1998년 5월부터 2005년 4월까지 원주기독병원에서 분리된 67주의 S. bovis를 대상으로 후향적으로 임상적 자료를 분석하였다. S. bovis의 동정은 API Strep 32를 이용하였고, 항균제 감수성은 디스크확산법으로 시험하였으며 penicillin의 최소억제농도는 E-test로 측정하였다. 결과：67주의 S. bovis 중에서 생물형 I은 18 (27%)였고 생물형 II는 49 (73%)였다. 검체별 분리빈도는 창상(37%), 혈액(19%) 및 소변(12%)의 순이었다. 혈액에서 분리된 13명의 S. bovis 균혈증 환자 중 생물형 I과 II는 각각 2명과 11명에서 분리되었고, 간질환(46%)이 가장 흔한 선행질환이었으며 위장관계 악성 종양이 있었던 환자는 없었다. 항균제감수성결과에서 penicillin에 각각 1주와 3주가 중간 및 내성이었고, 11주는 erythromycin에 내성이었으며 clindamycin에는 각각 2주와 5주가 중간 및 내성이었다. 결론：혈액에서 분리되는 S. bovis의 대부분은 생물형 II이었고, 간질환이 가장 흔한 선행질환이었으며 erythromycin과 clindamycin에 높은 내성률을 보였다.

Abstract

Background: The association of Streptococcus bovis biotypes with the type of clinical infection and underlying malignancies and data on antimicrobial susceptibility of S. bovis have rarely been reported in Korea. The aim of this investigation was to characterize the clinical features of patients with S. bovis bacteremia, and to determine the antimicrobial susceptibility of S. bovis strains isolated from blood cultures. Methods: The clinical data of 67 S. bovis isolates between May 1998 and April 2005 at Wonju Christian Hospital were retrospectively analyzed. The organism was identified by API Strep 32 kit and, for blood isolates, antimicrobial susceptibility testing was performed by the disk diffusion method and penicillin MICs were determined by E test. Results: Of the 67 S. bovis isolates, 18 (27%) were biotype I and 49 (73%) were biotype II. Isolation rates by specimen type were, in decreasing order, wound. 37%; blood, 19%; and urine, 12%. Of the 13 S. bovis bacteremias, 2 were caused by biotype I and 11 were by biotype II; liver diseases (46%) were the most common underlying diseases; none of the 13 patients had gastrointestinal malignancies; one and three isolates were intermediate and resistant to penicillin, respectively; eleven were resistant to erythromycin; two and five were intermediate and resistant to clindamycin, respectively. Conclusion: Most of the S. bovis isolates from blood were biotype II. Liver diseases were the most common underlying diseases. S. bovis isolates from blood displayed a high rate of resistance to erythromycin and clindamycin.

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