대구지역 한 대학병원에서 비결핵 항산균의 미생물학적 분포 및 임상적 특성
Microbiologic distribution and clinical features of nontuberculous mycobacteria in the tertiary hospital in Daegu
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Background: Recent studies have shown that the nontuberculosis mycobacterium (NTM) recovery rate in clinical cultures has increased within Korea. However, another study conducted by a secondary hospital within Daegu reported different results. Therefore, the purpose of this study is to understand and evaluate the microbiological distribution and clinical features of NTM in Daegu. Methods: A retrospective study was conducted on 11,672 respiratory specimens undergoing acid fast bacilli (AFB) culture from 6,685 subjects who visited Yeungnam University Respiratory Center from January 2012 to December 2013. Results: Of the 11,672 specimens undergoing AFB culture, 1,310 specimens (11.2%) showed positive results. Of these specimens, NTM was recovered from 587 specimens, showing a recovery rate of 44.8%. Identification test for NTM was performed on 191 subjects; the results were as follows: M. avium-intracellulare complex (MAC) 123 (64.4%), M. abscessus 20 (10.5%), M. kansasii 12 (6.3%), and 33 other NTM germ strains. Of the 382 subjects with NTM, 167 were diagnosed with pulmonary NTM disease (43.7%), however virulence differed depending on NTM strain. Multivariate analysis showed that nodular bronchiectasis, the nodules, and finding consistent with cavity under imaging study were statistically significant for triggering pulmonary NTM disease. AFB culture showing MAC and M. abscessus was statistically significant as well. Positive predictive value for NTM polymerase chain reaction (NTM-PCR) was 88.6%. Conclusion: Results for NTM recovery rate within the Daegu area were similar to those for the Seoul metropolitan area. We can assume that NTM infection is increasing in our community, therefore AFB-positive subjects (1) should undergo NTM-PCR, (2) should have their culture results checked for differentiation of mycobacterium tuberculosis complex (MTB) from NTM, and (3) undergo NTM identification test to confirm its type. Administration of treatment with the above results should be helpful in improving the patients’ prognosis.
Abstract
Background: Recent studies have shown that the nontuberculosis mycobacterium (NTM) recovery rate in clinical cultures has increased within Korea. However, another study conducted by a secondary hospital within Daegu reported different results. Therefore, the purpose of this study is to understand and evaluate the microbiological distribution and clinical features of NTM in Daegu. Methods: A retrospective study was conducted on 11,672 respiratory specimens undergoing acid fast bacilli (AFB) culture from 6,685 subjects who visited Yeungnam University Respiratory Center from January 2012 to December 2013. Results: Of the 11,672 specimens undergoing AFB culture, 1,310 specimens (11.2%) showed positive results. Of these specimens, NTM was recovered from 587 specimens, showing a recovery rate of 44.8%. Identification test for NTM was performed on 191 subjects; the results were as follows: M. avium-intracellulare complex (MAC) 123 (64.4%), M. abscessus 20 (10.5%), M. kansasii 12 (6.3%), and 33 other NTM germ strains. Of the 382 subjects with NTM, 167 were diagnosed with pulmonary NTM disease (43.7%), however virulence differed depending on NTM strain. Multivariate analysis showed that nodular bronchiectasis, the nodules, and finding consistent with cavity under imaging study were statistically significant for triggering pulmonary NTM disease. AFB culture showing MAC and M. abscessus was statistically significant as well. Positive predictive value for NTM polymerase chain reaction (NTM-PCR) was 88.6%. Conclusion: Results for NTM recovery rate within the Daegu area were similar to those for the Seoul metropolitan area. We can assume that NTM infection is increasing in our community, therefore AFB-positive subjects (1) should undergo NTM-PCR, (2) should have their culture results checked for differentiation of mycobacterium tuberculosis complex (MTB) from NTM, and (3) undergo NTM identification test to confirm its type. Administration of treatment with the above results should be helpful in improving the patients’ prognosis.
참고문헌 (25)
- 고원중, "항산균 도말양성 객담에서 비결핵성 마이코박테리아의 분리 비율", Tuberculosis and Respiratory Diseases, 54(1), pp.22~32 (2003), 대한결핵및호흡기학회
- 이정연, "한 대학병원에서 비결핵항산균의 분리 및 동정실태", Tuberculosis and Respiratory Diseases, 58(4), pp.385~391 (2005), 대한결핵및호흡기학회
- Koh WJ, "Clinical significance of nontuberculous mycobacteria isolated from respiratory specimens in Korea", Chest, 129, pp.341~348 (2006)
- 최순필, "일개 국립결핵병원에서 경험한 비결핵성 마이코박테리아 폐질환의 원인균과 임상상", Tuberculosis and Respiratory Diseases, 59(6), pp.606~612 (2005), 대한결핵및호흡기학회
- 이효원, "면역적격자에서 비결핵마이코박테리아의 폐감염", Tuberculosis and Respiratory Diseases, 53(2), pp.173~182 (2002), 대한결핵및호흡기학회
- "Diagnosis and treatment of disease caused by nontuberculous mycobacteria. This official statement of the American Thoracic Society was approved by the Board of Directors, March 1997. Medical Section of the American Lung Association", Am J Respir Crit Care Med, 156, pp.S1~S25 (1997)
- Griffith DE, "An official ATS", IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases, 2007, pp.175, 367~416
- Aberg JA, "Eradication of AIDS-related disseminated Mycobacterium avium complex infection after 12 months of antimycobacterial therapy combined with highly active antiretroviral therapy", J Infect Dis, 178, pp.1446~1449 (1998)
- Prince DS, "Infection with Mycobacterium avium complex in patients without predisposing conditions", N Engl J Med, 321, pp.863~868 (1989)
- 이재광, "일개 2차 의료기관에서의 비결핵성 마이코박테리아 분리비율 및 폐질환의 임상 경과", Tuberculosis and Respiratory Diseases, 67(3), pp.199~204 (2009), 대한결핵및호흡기학회
- Park YS, "Rapid increase of non-tuberculous mycobacterial lung diseases at a tertiary referral hospital in South Korea", Int J Tuberc Lung Dis, 14, pp.1069~1071 (2010)
- 오민수, "제주지역 호흡기 검체에서 비결핵 항산균 동정률의 증가", Annals of Clinical Microbiology, 16(1), pp.13~18 (2013), 대한임상미생물학회
- 이민경, "최근 2년간 호흡기 검체에서 분리된 비결핵 항산균 분포와 임상적 의의", Annals of Clinical Microbiology, 15(3), pp.98~103 (2012), 대한임상미생물학회
- 임인수, "Identification and Distribution of Nontuberculous Mycobacteria from 2005 to 2011 in Cheonan, Korea", Tuberculosis and Respiratory Diseases, 74(5), pp.215~221 (2013), 대한결핵및호흡기학회
- Lee MY, "Regional differences of nontuberculous mycobacteria species in Ulsan, Korea", J Thorac Dis, 6, pp.965~970 (2014)
- Joint Committee for the Revision of Korean Guidelines for Tuberculosis, Korean Centers for Disease Control and Prevention, "Korean guidelines for tuberculosis", Joint Committee for the Revision of Korean Guidelines for Tuberculosis, Korea Centers for Disease Control and Prevention, ~ (2014)
- O'Brien RJ, "The epidemiology of nontuberculous mycobacterial diseases in the United States. Results from a national survey", Am Rev Respir Dis, 135, pp.1007~1014 (1987)
- Tsukamura M, "Studies on the epidemiology of nontuberculous mycobacteriosis in Japan", Am Rev Respir Dis, 137, pp.1280~1284 (1988)
- Daley CL, "Pulmonary non-tuberculous mycobacterial infections", Int J Tuberc Lung Dis, 14, pp.665~671 (2010)
- 고원중, "Diagnosis and Treatment of Nontuberculous Mycobacterial Pulmonary Diseases: A Korean Perspective", Journal of Korean Medical Science, 20(6), pp.913~925 (2005), 대한의학회
- Good RC, "Isolation of nontuberculous mycobacteria in the United States, 1980", J Infect Dis, 146, pp.829~833 (1982)
- Hosker HS, "The prevalence and clinical significance of pulmonary infection due to non-tuberculous mycobacteria in Hong Kong", Respir Med, 89, pp.3~8 (1995)
- 신수, "16S Ribosomal RNA, Heat-shock Protein 65 및 RNA Polymerase-Subunit 유전자 염기서열분석을 통한 비결핵 마이코박테리아의 동정", Annals of Laboratory Medicine, 26(3), pp.153~160 (2006), 대한진단검사의학회
- 박철민, "중합효소연쇄반응-제한절편길이다형성을 이용한 비결핵항산균의 분리", Annals of Laboratory Medicine, 26(3), pp.161~167 (2006), 대한진단검사의학회
- 고원중, "Nontuberculous Mycobacterial Pulmonary Diseases in Immunocompetent Patients", Korean Journal of Radiology, 3(3), pp.1~157 (2002), 대한영상의학회