포도상구균의 유도형 Clindamycin 내성 검출을 위한 Vitek II 시스템 평가
Evaluation of the detectability of Vitek II System for Inducible Clindamycin Resistancein Staphylococci
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배경 : 많은 미생물 검사실은 자동화 장비를 이용하여 신속하게 항생제 감수성 검사를 실시하고 있다. 자동화된 액체배지 희석법은 대부분의 항생제 내성기전을 찾아낼 수 있으나 몇몇 미생물에서는 찾아내지 못하는 것으로 보고되고 있다. 본 연구에서는clindamycin 유도형 내성S. aureus의 검출에 있어 디스크 인접법과 자동화 액체배지희석법인 Vitek II 시스템을 비교해보고자하였다.방법 : Methicillin resistant Staphylococcus aureus (MRSA)183주와 methicillin susceptible Staphylococcus aureus (MSSA)17주로 구성된 총 20주의 S. aureus 임상분리주를 대상으로 검사를 실시하였다. 표준검사법으로 미국 Clinical and LaboratoryStandards Institute (CLSI)에서 추천하는 디스크 인접법을 시행했으며, Vitek II ID-GPI (bioMerieux, Durham, NC, USA)와 Vitek AST-P536 (bioMerieux, Durham, NC, USA)을 이용하여 균의 동정과 항균제감수성시험을 실시하였다. 결과 : 디스크 인접법과 Vitek II로 검사하였을 때S. aureus의 clindamycin의 내성률은 각각 89%와 56%로 나타났다. MRSA에서 유도형 내성을 보인 60주중 1주만이 Vitek II에서 clinda-mycin에 대해 내성을 보였으며, 나머지는 모두 감수성 결과를 보였다. 또한, MSSA에서 Vitek II는 유도형 내성 5주 모두 clinda-mycin 감수성으로 보고하여 유도형 clindamycin 내성S. aureus를 찾지 못하였다. 결론 : S. aureus에 대한 유도형 clindamycin 내성을 찾기 위한 방법으로 Vitek II 시스템은 부적절하며 CLSI에서 추천하는 디스크 인접법을 사용해야 할 것이다.
Abstract
Background : While broth based antimicrobial susceptibility test methods work well for the detection of the majority of antimicrobial resistance mechanisms, antimicrobial resistance mechanism in some microorganisms may not be detected by these methods. The purpose of this study was to compare Vitek II system with a standard method for the ability to detect inducible clindamycin resistance in Staphylococcus aureus. Methods : Of 200 clinical isolates of S. aureus tested, 183 were methicillin resistant (MRSA) and 17 were methicillin susceptible (MSSA). A disk approximation test (Clinical Laboratory Standards Institute; CLSI, Wayne, PA, USA) was performed as the standard method by placing standard erythromycin and clindamycin disks in adjacent positions. Vitek II ID-GPI (bioMerieux, Durham, NC, USA) was used for identification and Vitek AST-P536 (bioMerieux, Durham, NC, USA) for antimicrobial susceptibility tests. Results : Clindamycin resistance rates of S. aureus tested by disk diffusion and Vitek II system were 89% and 56%, respectively. All but one inducible clindamycin resistant MRSA isolates were susceptible to clindamycin by Vitek II system. Five inducible clindmycin resistant MSSA isolates were all susceptible to clindamycin by Vitek II system. Vitek II system did not detect the inducible clindamycin resistance in S. aureus. Conclusions : Our results showed that Vitek II system was unacceptable for the detection of inducible clindamycin resistance in S. aureus. We suggests that the disk approximation test should be used to detect the inducible clindamycin resistance in S. aureus
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