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Escherichia coli, Klebsiella species, Proteus mirabilis 임상분리주에서 MicroScan NegCombo Panel Type 44의 Extended-Spectrum β-Lactamase 검출능 평가

Evaluation of the MicroScan NegCombo Panel Type 44 for Detection of Extended-Spectrum β-Lactamase among Clinical Isolates of Escherichia coli, Klebsiella species, and Proteus mirabilis

김미나|정재우|성흥섭|윤남섭|고선영|송아진
대한진단검사의학회 (Korean Society For Laboratory Medicine)|2009.02|Annals of Laboratory Medicine|제29권 제1호|pp. 35-40

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Extended-spectrum β-lactamasesNegCombo Type 44plasmid-mediated AmpC β-lactamases
주제분류병리학

초록

배경 : Extended-spectrum β-lactamase (ESBL) 생성 균 주의 빠르고 정확한 검출은 감염된 환자에게 적절한 항균제 치료 를 하기 위해 중요하다. Ceftazidime/clavulanic acid와 cefotaxime/ clavulanic acid를 이용해 ESBL 생성 Enterobacteriaceae를 확인할 수 있는 MicroScan NegCombo Panel Type 44 (Dade Behring, USA) 가 출시되어 그 수행능을 평가하였다. 방법 : 2007년 8월 30일부터 9월 20일까지 한 환자에서 처 음 분리된 Escherichia coli 106균주, Klebsiella pneumoniae 81균주, Klebsiella oxytoca 11균주, Proteus mirabilis 8균주 를 계대배양하여 Type 32 패널, Type 44 패널로 검사하였다. 그 결과를 CLSI의 표현형적 확인검사와 디스크근접검사의 결 과와 비교하였다. Cefotetan에 감수성이지 않은 균주 또는 Type 44 패널에서“Possible ESBL, unable to interpret confirm test (Possible ESBL)”결과일 경우 boronic acid 디스크를 이 용하여 AmpC β-lactamase (AmpC) 생성 확인 검사를 실시하 였다. 결과 : 206균주 중 44균주(21.4%)가 CLSI의 표현형적 확인 검사 혹은 디스크근접검사에서 ESBL을 생성하였으며, E. coli 27균주, K. pneumoniae 14균주, K. oxytoca 2균주, P. mirabilis 1균주가 포함되었다. Type 44 패널에서 38균주가 “Confirmed ESBL”로 판독되었고 모두 ESBL 생성 균주로 확 인되었다. K. pneumoniae 14균주는“Possible ESBL”로 판독 되었고 이 중 6균주는 ESBL과 AmpC를 동시에 생성하는 균주 였고 8균주는 AmpC만 생성하는 균주였다. 결론 : Type 44 패널은 ESBL을 생성하는 E. coli, Klebsiella spp., P. mirabilis를 검출하는데 우수한 수행능을 보였 다. “Confirmed ESBL”로 판독된 경우 별도의 확인검사 없이 ESBL로 보고할 수 있었으며, “Possible ESBL”로 판독된 경우 는 AmpC 생성을 감별하는 검사가 필요하였다.

Abstract

Background : Accurate and rapid detection of extended-spectrum β-lactamases (ESBLs) is important in guiding proper antimicrobial therapy for infected patients. We evaluated the performance of MicroScan NegCombo Type 44 panel (Dade Behring, USA), which was developed to confirm ESBLproducing Enterobacteriaceae using ceftazidime/clavulanate and cefotaxime/clavulanate. Methods : From August 30 to September 20, 2007, 206 non-duplicate clinical isolates, including 106 Escherichia coli, 81 Klebsiella pneumoniae, 11 Klebsiella oxytoca, and 8 Proteus mirabilis were subcultured and tested with Type 32 and Type 44 panels. The results were compared with those of the CLSI phenotypic confirmatory test (CLSI-PCT) and disk approximation test (DAT). Isolates not susceptible to cefotetan or flagged as ‘‘Possible ESBL, unable to interpret confirm test (Possible ESBL)’’ on Type 44 panel were tested with boronic acid disks to confirm AmpC β-lactamases (AmpC) production. Results : Of the 206 isolates tested, 44 (21.4%) produced ESBL by CLSI-PCT or DAT, including 27 E. coli, 14 K. pneumoniae, 2 K. oxytoca, and 1 P. mirabilis. Thirty-eight isolates flagged as ‘‘Confirmed ESBL’’ on Type 44 panel were all confirmed as ESBL-producers. Of 14 K. pneumoniae flagged as ‘‘Possible ESBL’’, 6 were confirmed as ESBL and AmpC co-producers and 8 as AmpC-producers. Conclusions : Type 44 panel showed an excellent performance in detecting ESBL-producing E. coli, Klebsiella spp., and P. mirabilis. When flagged as ‘‘Confirmed ESBL’’, no other confirmatory test was necessary to report as ESBL; however, ‘‘Possible ESBL’’ required a differential test for AmpC production.

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