2009∼2018년 혈액배양으로부터 분리된 Candida 균종의 항진균제 감수성의 경향
Trends of Antifungal Agent Susceptibility of Candida Strains Isolated from Blood Cultures in 2009∼2018
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혈류 감염(BSI)의 주요 원인균의 하나로 입원환자에서 이환율과 사망률을 높이는 칸디다의 항진균제 내성률을 조사하여 칸디다 혈증(candidemia)의 경험적 치료 방침에 중요한 정보를 제공하고자 한다. 2009∼2018년 S병원의 혈액배양 검사에서 분리된 Candida 균주(973건) 중 Candida spp. (932 균주)에 대한 fluconazole 감수성 시험결과에서 4.7% (N=44)가 내성(resistant, R)을 보였고 C. albicans, C. parapsilosis, C. tropicalis, C. glabrata에서 내성 균주를 확인하였다. 또한, Candida spp. (947 균주)의 amphotericin B에 대한 감수성 결과에서는 내성(N=6, 0.6%)이 나타났고, 전체 Candida spp. (973 균주)에 대한 flucytosine 감수성 시험에서는 내성(N=23, 2.4%)을 보였다. Candida spp. (768 균주)의 voriconazole에 대한 감수성 시험에서는 내성(N=24, 3.1%)을 보였다. C. albicans는 fluconazole (N=23, 6.9%), voriconazole (N=21, 6.0%)이 내성이고 통계학적으로 C. albicans과 non-albicans Candida species은 fluconazole (P=0.039), voriconazole (P＜0.001)로 나타났다. 칸디다 혈증의 감염률을 이해하고 예방하기 위한 감시 시스템이 요구되고 항진균제의 적절한 투여와 치료가 요구된다. 따라서 항진균제 감수성 결과의 모니터링을 통한 칸디다의 내성을 추적하는 감염감시활동 정책이 필요할 것으로 사료된다.
Abstract
Candida is one of the most common causes of bloodstream infections and a leading cause of morbidity and mortality among hospitalized patients. The purpose of this study was to provide important information for formulating empirical treatment plans for candidemia by investigating the antifungal resistance rate of Candida. Among the Candida strains (973 cases) isolated from blood culture tests at the S hospital in 2009∼2018, 4.7% (N=44) comprising the Candida spp. (932 strains) showed resistance to fluconazole. The resistant strains included C. albicans, C. parapsilosis, C. tropicalis, and C. glabrata. In addition Candida spp. (947 strains) showed resistance to amphotericin B (N=6, 0.6%), flucytosine (N=23, 2.4%) and voriconazole (N=24, 3.1%). C. albicans was resistant to fluconazole (N=23, 6.9%) and voriconazole (N=21, 6.0%), The statistical analysis showed that C. albicans and non-albicans Candida species were resistant to fluconazole (P=0.039) and voriconazole (P＜0.001). A monitoring system to understand the rate of candidiasis infections in a hospital setting is required. It is also important to make the right choice of the antifungal agent based on drug susceptibility patterns. Therefore, an infection surveillance policy that tracks Candida resistance through regular antifungal susceptibility tests is necessary.
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