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귀 검체에서 분리된 효모 균종과 항진균제 감수성 성적

Species Distribution and Antifungal Susceptibility of Yeasts Isolated from Ear Specimens

김수현|최민지|신종희|원은정|권용준|변승아
대한임상미생물학회 (Korean Society of Clinical Microbiology)|2019.12|Annals of Clinical Microbiology|제22권 제4호|pp. 81-89|DOI https://doi.org/10.5145/ACM.2019.22.4.81

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키워드

YeastFluconazoleCandida aurisAntifungal resistanceEar

초록

배경: Candida auris는 우리나라와 일본 환자의 귀배양에서 처음 분리 보고된 바 있으나, 귀 검체에서 분리되는 효모균의균종 분포 및 항진균제 감수성에 관해서는 알려진 바가 많지 않다. 방법: 본 연구는 1개 대학병원에서 2014년 1월부터 2017년 12월까지 최근 4년 동안 귀 검체에서 분리된 효모균의 균종분포를 알아보고, 분리 균주의 항진균제 감수성 성적을 조사하였다. 효모균의 동정은 matrix-assisted laser desorption/ionization time-of-flight mass spectrometry을 이용하여 시행하였고, 필요한 경우 염기서열분석법을 시행하였다. 각 균주의 항진균제 minimal inhibitory concentrations (MICs) 검사는 Clinical and Laboratory Standards Institute (CLSI) 액체배지미량희석법을 이용하여 시행하였다. 결과: 해당 기간동안 귀에서 분리된 효모균은 총 81주로서 Candida parapsilosis (28주, 34.6%)가 가장 많았고, 다음으로는C. auris (23주, 28.4%), Candida metapsilosis (8주, 9.9%), Candida orthopsilosis (7주, 8.6%), Candida albicans (6주, 7.4%) 순이었다. Fluconazole, voriconazole, amphotericin B, caspofungin 및 micafungin에 대한 MIC 분포는 각각 0.125-＞64 μg/mL, ≤0.03-4 μg/mL, 0.25-1 μg/mL, 0.125-1 μg/mL 및 ≤0.03-2 μg/mL이었다. 전체 균주 중 fluconazole MIC가 4 μg/mL 이상인 균주는 총 36주(44.4%)였다. 특히 C. auris 23주 중 19주(82.6%)가 fluconazole에 MIC 32 μg/mL 이상이었다. 균주대부분은 만성 중이염 환자(85.2%)에서 분리되었다. 결론: C. parapsilosis complex와 C. auris는 귀에서 분리되는 효모 균주의 대다수를 차지하였다. 특히, C. auris는 대부분fluconazole에 내성을 보였으며, 그 외 다른 균종들 역시 상대적으로 fluconazole MIC가 높은 것을 알 수 있었다. [Ann Clin Microbiol 2019;22:81-89]

Abstract

Background: Candida auris was first isolated from the ears of Japanese and Korean patients. However, the prevalence of yeast isolates from ear cultures and their antifungal susceptibility profiles in these nations remain unclear. Methods: We assessed yeast isolates recovered from ear cultures from a university hospital in Korea over a 4-year period from January 2014 to December 2017. Species identification was performed by matrix- assisted laser desorption/ionization time-of-flight mass spectrometry and/or sequence analysis. Antifungal minimal inhibitory concentrations (MICs) were determined using the broth microdilution method of the Clinical and Laboratory Standards Institute. Results: Among 81 non-duplicate isolates from ear cultures, Cadida parapsilosis was the most frequently detected yeast species (34.6%), followed by C. auris (28.4%), Candida metapsilosis (9.9%), Candida orthopsilosis (8.6%), Candida albicans (7.4%), and others (11.1%). The MICs of the isolates were 0.125 to ＞ 64 μg/mL, ≤0.03 to 4 μg/mL, 0.25 to 1 μg/mL, 0.125 to 1 μg/mL, and ≤0.03 to 2 μg/mL for fluconazole, voriconazole, amphotericin B, caspofungin, and micafungin, respectively. Of the 81 isolates, 44.4% (36/81) showed decreased susceptibility to fluconazole (MIC ≥4 μg/mL). Of the 23 C. auris isolates, 19 (82.6%) had a fluconazole MIC of ≥32 μg/mL. None of the isolates showed resistance to amphotericin B or echinocandins. Most of these patients suffered from chronic otitis media (84%). Conclusion: Candida parapsilosis complex and C. auris were the yeast species identified most frequently from ear cultures and they exhibited a high rate of fluconazole non-susceptibility, particularly C. auris. (Ann Clin Microbiol 2019;22:81-89)

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