마이코박테리아 검출을 위하여 MGIT 양성 신호를 보인 세균에오염된 검체 재처리 과정의 효율성 평가
Evaluation of the Effectiveness of a Re-decontaminating Process with Bacterial Contaminated Specimens Showing a Positive MGIT Signal for the Detection of Mycobacteria
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초록
BACTEC MGIT 960 system의 mycobacteria growth indicator tube (MGIT) 오염 제거과정의 효율성을 평가하기 위하여 기존 3% Ogawa media와 마이코박테리아의 배양 양상을 비교하였다. 검체는 5% sodium hydroxide (NaOH)과 0.5% N-acetyl-L-cysteine (NALC)를 처리하여 MGIT와 Ogawa media에 접종하였다. 배양된 마이코박테리아는 결핵균(mycobacterium tuberculosis, TB) 항원 kit로 동정하였다. 만약 MGIT에서 5일 이내에 오염균 배양되면 오염제거 과정을 반복하였다. BACTEC MGIT 960 system에 장착한 MGIT 4,790건 중 1,190건(24.8%)이 배양 양성의 결과를 보였고 이중 278건을 재처리 하였다. MGIT와 Ogawa media 사이의 결과를 비교하였을 때 불일치 결과(weighted kappa value: 0.283)를 보였고, 특히 TB 1건과 nontuberculous mycobacteria (NTM) 10건이 재처리한 MGIT에서만 배양되었다. 비록 소수이지만 재처리 과정으로 검출할 수 없었던 마이코박테리아를 검출하였다. 이는 마이코박테리아 검출을 위하여 MGIT와 Ogawa media을 동시에 시행할 뿐 아니라 MGIT에서 위양성을 보이는 경우, 검체의 재처리 과정을 추가하는 것이 필요하다 생각된다.
Abstract
A comparative study between commercially available mycobacteria growth indicator tubes (MGIT) in the BACTEC MGIT 960 System and the conventional Ogawa media was carried out to assess the effectiveness of the re-decontaminating process for the recovery of mycobacteria. Processed specimens with 5% sodium hydroxide and 0.5% N-acetyl-L-cysteine were inoculated into MGIT and Ogawa media. The acid fast bacilli (AFB) recovered from the cultures were identified using a mycobacterium tuberculosis (TB) antigen kit. If contaminants were observed in the MGIT tubes within five days, a decontaminating process was repeated. A total of 1,190 out of 4,790 (24.8%) specimens showed positive results using the BACTEC MGIT 960 system. Among them, 278 specimens were reprocessed. When the MGIT and Ogawa results were compared, it showed discordant results (weighted kappa value: 0.283). One TB and 10 nontuberculous mycobacteria (NTM) were newly detected in MGIT only. The likely benefit of the re-decontaminating process is the detection of additional mycobacteria that could not be detected without a re-decontaminating process despite being small in number. In addition to the combination of MGIT and Ogawa, the re-decontaminating process is recommended in the case of contaminations to recover mycobacteria.
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