혈액배양에서 VITEK MS와 VITEK 2 System을 이용한 신속 항생제 감수성 시험의 유용성 평가
An Evaluation of the Rapid Antimicrobial Susceptibility Test by VITEK MS and VITEK 2 Systems in Blood Culture
2
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
본 연구에서는 혈액배양에서 신속한 세균 동정과 항생제 감수성 시험(antibiotic susceptibility test, AST) 결과를 얻기 위해혈액배양 양성배지에서 계대배양 없이 세균을 VITEK MS와VITEK 2 시스템에 직접 접종하였으며, 도출된 결과를 표준방법과 비교하여, 그 신뢰도와 정확도를 평가하였다. 혈액배양 양성시료에서 직접 결과는 표준방법 AST 결과와 비교하였을 때, 97.9% (1,936/1,978)의 전체적인 일치율을 보였다. 그람양성 세균은 97.2% (1,051/1,081)의 일치율을 나타냈으며, 매우 중대한오차율은 0.5% (5/1081), 중대한 오차율은 0.1% (1/1,081), 사소한 오차율은 2.2% (24/1,081)의 결과를 나타냈다. 두 방법 간불일치의 주요 원인균은 Staphylococcus epidermidis이었고, 그 중 gentamicin (N=9)과 fusidic acid (N=8)에서 높은 오류를나타냈다. 그람음성 세균 중 전체적인 일치율은 98.6% (885/897)였고, 사소한 오류는 1.4% (12/897)였다. 그람음성세균의 불일치 주요 원인균은 Escherichia coli와 Pseudomonas aeruginosa였으며, 그 중 amoxicillin/clavulanic acid (N=3)에서 높은 오류를 나타냈다. 직접법에 의한 AST 방법은CLSI 기준을 충족하였고, 결과 보고 시간을 24시간 단축할 수있었지만, 매우 큰 오류가 있는 항생제에 대해서는 디스크확산법으로 추가적인 검사를 시행한 후 보고해야 한다는 것을 알 수있었다. 이러한 연구 결과들을 토대로 혈액배양 시료에서 직접AST를 실시하는 방법은 정확하고 결과를 보고하는데 까지 소요되는 시간을 크게 감소시킬 수 있기 때문에 환자의 정확하고 효율적인 치료에 유용하게 활용될 수 있을 것으로 사료된다.
Abstract
The results of rapid antimicrobial susceptibility test (AST) in blood cultures were obtained by inoculating the bacteria directly into the VITEK MS and the VITEK 2 systems without subculturing in the blood culture positive medium. The obtained results were compared with the results using a standard method to evaluate their reliability and accuracy. The direct AST results in blood culture positive specimens were 97.9% (1,936/1,978), consistent with the standard AST results. Gram-positive bacteria showed a concordance rate of 97.2% (1,051/1,081), a very major error rate of 0.5% (5/1,081), a major error rate of 0.1% (1/1,081), and a minor error rate of 2.2% (24/1,081). Staphylococcus epidermidis was the main cause of discordance, and gentamicin (N=9) and fusidic acid (N=8) showed high errors. The overall concordance rate and minor error among the Gram-negative bacteria were 98.6% (885/897) and 1.4% (12/897), respectively. Escherichia coli and Pseudomonas aeruginosa were the major causative bacteria of Gram-negative bacteria. Among them, amoxicillin/clavulanic acid (N=3) showed high error. Direct AST met the CLSI criteria and shortened the reporting time by 24 hours; however, we found that there was a need to perform an addition test via disk diffusion for antimicrobials with very large errors. These results suggest that the method of direct AST in blood culture positive medium may be very useful in efficiently treating patients.
참고문헌 (17)
- Watson RS, "The epidemiology of severe sepsis in children in the United Stated", Am J Respir Crit Care Med, 167(5), pp.695~701 (2003)
- Kim JH, "Influence of full-time intensivist and the nurse-to-patient ratio on the implementation of severe sepsis bundles in Korean intensive care units", J Crit Care, 27, pp.414.e11~414.e21 (2012)
- Machen A, "Same day identification and full panel antimicrobial susceptibility testing of bacteria from positive blood culture bottles made possible by a combined lysis-filtration method with MALDI-TOF VITEK mass spectrometry and the VITEK2 system", PLoS One, 9, pp.e87870~ (2014)
- Schneiderhan W, "Work flow analysis of around-the-clock processing of blood culture samples and integrated MALDI-TOF mass spectrometry analysis for the diagnosis of bloodstream infections", Clin Chem, 59(11), pp.1649~1656 (2013)
- Prod’hom G, "Matrix-assisted laser desorption ionization-time of flight mass spectrometry for direct bacterial identification from positive blood culture pellets", J Clin Microbiol, 48(4), pp.1481~1483 (2010)
- Romero-Gómez MP, "Identification and susceptibility testing of microorganism by direct inoculation from positive blood culture bottles by combining MALDI-TOF and Vitek-2 Compact is rapid and effective", J Infect, 65(6), pp.513~520 (2012)
- Stevenson LG, "Rapid identification of bacteria in positive blood culture broths by matrix-assisted laser desorption ionization-time of flight mass spectrometry", J Clin Microbiol, 48(2), pp.444~447 (2009)
- Kok J, "Identification of bacteria in blood culture broths using matrix-assisted laser desorption-ionization SepsityperTM and time of flight mass spectrometry", PLoS One, 6, pp.e23285~ (2011)
- Ling TK, "Evaluation of the VITEK 2 system for rapid direct identification and susceptibility testing of gram-negative bacilli from positive blood cultures", J Clin Microbiol, 41(10), pp.4705~4707 (2003)
- Fothergill A, "Rapid identification of bacteria and yeasts from positive-blood-culture bottles by using a lysis-filtration method and matrix-assisted laser desorption ionization-time of flight mass spectrum analysis with the SARAMIS database", J Clin Microbiol, 51(3), pp.805~809 (2013)
- Lavergne RA, "An extraction method of positive blood cultures for direct identification of Candida species by Vitek MS matrix-assisted laser desorption ionization time of flight mass spectrometry", Med Mycol, 51(6), pp.652~656 (2013)
- Ferreira L, "Microorganisms direct identification from blood culture by matrix-assisted laser desorption", ionization time-of flight mass spectrometry, 2011, pp.17(4), 546~551
- Monteiro J, "Fast and reliable bacterial identification direct from positive blood culture using a new TFA sample preparation protocol and the VitekⓇMS system", J Microibiol Methods, 109, pp.157~159 (2015)
- Marinach-Patrice C, "Rapid species diagnosis for invasive candidiasis using mass spectrometry", PLos One, 5, pp.e8862~ (2010)
- Clinical and Laboratory Standards Institute, "Performance standards for antimicrobial susceptibility testing. 24th Informational supplement, M100-S24", Clinical and Laboratory Standards Institute, ~ (2014)
- 홍석경, "3차 대학병원 내과계 중환자실 내 중증 패혈증의 유병률과 예후인자", Acute and Critical Care, 24(1), pp.28~32 (2009), 대한중환자의학회
- Angus DC, "Epidemiology of severe sepsis in the United States:analysis of incidence, outcome, and associated costs of care", Crit Care Med, 29(7), pp.1303~1310 (2001)