실용적인 Helicobacter pylori 항균제감수성검사법의 확립을 위한 네 가지 검사법의 비교
Evaluation of Four Methods for Antimicrobial Susceptibility Testing of Helicobacter pylori in Routine Practice
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배경：Helicobacter pylori는 배양 조건이 까다롭고 배양 기간이 길어 항균제감수성검사가 어렵다. 현재까지 개발되어있는 여러 감수성검사방법 중, 임상미생물검사실에서 일상적으로 사용할 수 있는 실용적인 H. pylori 의 항균제감수성검사법을 찾고자 하였다. 방법：소화성 궤양 환자의 위생검 조직에서 분리한 H. pylori 37 균주를 대상으로, amoxicillin (AMX), clarithromycin (CLR), metronidazole (MTZ)의 세 항균제에 대하여, 액체배지희석법, Mueller-Hinton 혈액한천배지(MH BAP)를 사용한 Etest, egg yolk emulsion (EYE) 배지를 사용한 Etest, EYE배지를 사용한 디스크확산법의 네 가지 항균제 감수성검사법을 실시하였다. 결과：AMX 내성인 균주는 발견되지 않았으며, 네 방법의 감수성 결과는 거의 일치하였다. CLR에 내성인 균주는10.8%였으며, 네 가지 방법의 결과가 일치하였다. MTZ의 경우, 변형 액체배지희석법으로 최소억제농도가 32 mg/L이상이었던 네 균주는 네 방법의 결과가 모두 일치하였으나, 최소억제농도가 4 mg/L 이하이었던 20균주의 경우, 감수성 category 판정에서는 모두 일치하였으나, 최소억제농도 및 억제대의 크기는 상당한 차이를 나타내었다. 변형 액체배지희석법으로 MTZ의 최소억제농도가 8 mg/L 및 16 mg/L이었던 균주의 경우, 네 방법간에 상당한 차이를 나타내었다. 그러나 Etest EYE법과 Etest MH BAP법은 100%의 category 일치율을 나타내었다. 결론：임상미생물검사실에서 일상적으로 H. pylori 감수성검사를 시행할 경우, AMX 및 CLR의 감수성검사에는 EYE배지나 MH BAP를 사용한 디스크확산법을 사용할 수 있을 것으로 추정된다. 그러나 MTZ의 경우에는 네 가지 방법의 일치도가 좋지 않았으므로 MH BAP나 EYE배지를 사용하는 Etest법과 디스크법을 모두 사용하는 것이 바람직할 것 같다.
Abstract
Background: We compared currently available four antimicrobial susceptibility test methods for H. pylori to find out a practical method suitable for testing a few strains of H. pylori at a time in the clinical microbiology laboratory. Methods: With 37 clinical isolates of H. pylori, antimicrobial susceptibility tests were performed against amoxicillin (AMX), clarithromycin (CLR), and metronidazole (MTZ) using disk diffusion method with egg yolk emulsion (EYE) media, E test with EYE and Mueller Hinton blood agar plate (MH BAP), and modified broth microdilution methods (mBMD). Results: The results of AMX and CLR showed a complete agreement between the four methods. For MTZ, however, a significant discrepancy was observed between the results obtained by the four methods. In four strains exhibiting high minimal inhibitory concentrations (MIC, ≥ 32 mg/L) to MTZ, category agreement was excellent, but correlation was not good in 13 strains with the MTZ MICs of 8 to 16 mg/L. In 20 strains with MTZ MICs between 0.25 mg/L and 4 mg/L, category agreement was excellent, but correlation between MICs or inhibitory zone diameters was not good. Etest EYE and Etest MH BAP methods showed a 100% agreement in the susceptibility category of MTZ. Conclusion: In routine practice, the most practical method for testing susceptibility of H. pylorito AMX and CLR seems to be the disk diffusion method with EYE or MH BAP. But for MTZ, a duplicate test using both Etest and disk diffusion test is recommended until more standardized, economical, and technically easier test methods become available.
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