임상미생물검사 신빙도 조사 결과보고(2000)
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임상미생물검사 신빙도 조사 결과보고(2000). 대한임상검사정도관리협회 임상미생물분과위원회 김의종(집필대표), 강정옥, 김미나, 김민중, 김성일, 이경원, 이도현, 이장호, 이남용, 이창규, 신종희, 장철훈, 최혜심. Table 1. Microorganisms distributed for External Quality Assessment of Clinical Microbiology Laboratory in 2000. Specimen number. Trial. Microorganism. - PowerPoint PPT PresentationTRANSCRIPT
임상미생물검사 신빙도 조사 결과보고 (2000)
대한임상검사정도관리협회 임상미생물분과위원회대한임상검사정도관리협회 임상미생물분과위원회
김의종김의종 (( 집필대표집필대표 ), ), 강정옥강정옥 , , 김미나김미나 , , 김민중김민중 , , 김성일김성일 , , 이경원이경원 , , 이도현이도현 , , 이장호이장호 , , 이남용이남용 , , 이창규이창규 , , 신종희신종희 , ,
장철훈장철훈 , , 최혜심최혜심
Table 1. Microorganisms distributed for External Quality Assessment of Clinical Microbiology Laboratory in 2000
Trial Specimen
number
Microorganism Source
I
II
MB0001MB0002MB0003MB0004MB0005
MB0006MB0007MB0008MB0009MB0010
Klebsiella oxytocaEnterococcus faecalisSalmonella spp. Group DProteus vulgarisStaphylococcus aureus
Clinical isolateATCC 29212Clinical isolateATCC 49132ATCC 25923
Staphylococcus aureusEnterococcus faecalisE. coliPseudomonas aeruginosaKlebsiella pneumoniae
ATCC 25923ATCC 29212ATCC 25922ATCC 27853ATCC 700603
Table 2. Performance on the identification of microorganisms distributed for External Quality Assessment of Clinical Microbiology Laboratory in 2000
Specimen Number
No. of laboratories
No. of laboratories indicatedlevel of performance
Good Acceptable
Not acceptable
MB0001MB0002MB0003MB0004MB0005
MB0006MB0007MB0008MB0009MB0010
Klebsiella oxytocaEnterococcus faecalisSalmonella spp. Group DProteus vulgarisStaphylococcus aureus
Staphylococcus aureusEnterococcus faecalisE. coliPseudomonas aeruginosaKlebsiella pneumoniae
217217217217217
225225225225225
209154151209213
217175223213222
-40471-
-35-91
8231974
815232
Microorganisms
Not acceptable for the identification
Enterococcus faecalisEnterococcus faecalisMB0002 10.6% (23/217) MB0002 10.6% (23/217) MB0007 6.7% (15/225)MB0007 6.7% (15/225)
Salmonella Salmonella spp. Group D spp. Group D
8.8% (19/217)8.8% (19/217)
Catalase-negative, gram-positive cocci
with bile-esculin-positive
Enterococcus Group D streptococci
6.5% NaCl broth Growth No growth
PYR test + -
PYR: L-pyrrolidonyl-naphthylamide
Group D streptococci: S. bovis, S. equinus
Enterococcus spp.
Motility Yellow colony
E. faecalis - -
E. faecium - -
E. gallinarum + -
E. casseliflavus + +
TSI LIA
Salmonella spp.
TSI agar: K/Ag+, K/Ag-
Lysine iron agar: K/K+
MacConkey agar
SS agar
XLD agar
Table 3-1. Performance on the disk-diffusion antibiotic susceptibility tests (mm) of microorganisms distributed for External Quality Assessment of Clinical Microbiology Laboratory in 2000
Specimennumber
Microorganisms and antibiotics
No. oflab Good
Not Acceptable
less thanlower limit
more thanupper limit
MB0001 K. oxytoca Cephalothin 153 145(94.8%) NA* 8(5.2%) Cefotaxime 146 94(64.4%) 52(35.6%) NAMB0002 E. faecalis
Ampicillin 170 165(97.1%) 5(2.9%)NA
Vancomycin 170 105(61.8%) 65(38.2%)
NAMB0003 Salmonella Group D
Ampicillin 170 168(98.8%) 2(1.2%)NA
SXT 131 131(100%) 0NAMB0004 P. vulgaris
Cephalothin 154 93(60.4%) NA 61(39.6%)
Gentamicin 174 172(98.8%) 2(1.2%)NA
*NA: not applicable
Salmonella, Shigella
항생제 감수성 검사항생제 감수성 검사AmpicillinAmpicillinCiprofloxacinCiprofloxacinTrimethoprim/sulfamethoxazoleTrimethoprim/sulfamethoxazole
11 세대세대 , 2, 2 세대 세팔로스포린은 검사하지 세대 세팔로스포린은 검사하지 않는다않는다 ..
장외에서 분리된 장외에서 분리된 SalmonellaSalmonellaChloramphenicol, cefotaxime Chloramphenicol, cefotaxime 추가추가
Salmonella, Shigella 33 세대 세팔로스포린 세대 세팔로스포린 ((ceftriaxone, cefotaxime, ceftriaxone, cefotaxime,
cefoperazone cefoperazone 등등 )) 에서 중간 에서 중간 ((intermediate) intermediate) 또는 또는 내성으로 나오면내성으로 나오면 , , ESBL testESBL test 를 실시한다를 실시한다 ..
ESBL: Extended-spectrum ESBL: Extended-spectrum -lactamase-lactamase거의 모든 세팔로스포린으로 치료되지 않는다거의 모든 세팔로스포린으로 치료되지 않는다 ..검사에서 감수성으로 나와도 내성으로 보고한다검사에서 감수성으로 나와도 내성으로 보고한다 ..
ESBL-Shigella: ESBL-Shigella: 세계 최초로 출현세계 최초로 출현 !!!!!!!!!!!! ESBL-Salmonella: ESBL-Salmonella: 간혹 분리되고 있음간혹 분리되고 있음
Table 3-2. Performance on the disk-diffusion antibiotic susceptibility tests (mm) of microorganisms distributed for External Quality Assessment of Clinical Microbiology Laboratory in 2000
Specimennumber
Microorganisms and antibiotics
No. oflab Good
Not Acceptable
less thanlower limit
more thanupper limit
MB0005 S. aureus Oxacillin 170 139(81.8%) 15(8.8%)
16(9.4%) Vancomycin 175 104(59.4%) 67(38.3%)
4(2.3%)MB0006 S. aureus
Oxacillin 172 151(87.8%) 15(8.7%)6(3.5%)
Vancomycin 178 126(70.7%)51(28.7%) 1(0.6%)MB0007 E. faecalis
Ampicillin 172 169(98.3%) 3(1.7%)NA
Vancomycin 173 117(67.6%) 56(32.4%)NA
*NA: not applicable
0
10
20
30
40
50
60
6 8 10 12 14 16 18 20 22 24 26
MB0005MB0006
S. aureus (ATCC 25923), Vancomycin
Unacceptable: MB0005 - 38.3% (67/175)
MB0006 - 28.7% (51/178)
Staphylococcus spp. 에서 vancomycin disk
15 mm 이상이어야 감수성으로 판정하고 ,
14 mm 이하이면 반드시 최소억제농도를 측정하여
4 g/mL 이하이면 감수성이며 ,
4 g/mL 보다 크면 내성을 의심해야 한다 .
Table 3-3. Performance on the disk-diffusion antibiotic susceptibility tests (mm) of microorganisms distributed for External Quality Assessment of Clinical Microbiology Laboratory in 2000
Specimennumber
Microorganisms and antibiotics
No. oflab Good
Not Acceptable
less thanlower limit
more thanupper limit
MB0008 E. coli Ampicillin 172 151(87.7%) 13(7.6%) 8(4.7%) Gentamicin 179 154(86.1%) 11(6.1%)
14(7.8%)MB0009 P. aeruginosa
Piperacillin 136 125(91.9%) 11(8.1%) 0 Gentamicin 178 142(79.8%) 2(1.1%)
34(19.1%)MB0010 K. pneumoniae
Cefotaxime 148 136(91.8%) 10(6.8%) 2(1.4%) Imipenem 156 154(98.7%) 2(1.3%) 0
Table 4-1. Performance on the automated or Etest antibiotic susceptibility tests ( g/ml) of bacteria distributed for External Quality Assessment of Clinical Microbiology Laboratory in 2000
Specimennumber
Microorganisms and antibiotics
No. oflab Good
Not Acceptable
less thanlower limit
more thanupper limit
MB0001 K. oxytoca Cephalothin 64 61(95.3%) 3(4.7%) NA* Cefotaxime 62 60(96.8%) NA 2(3.2%)
MB0002 E. faecalis Ampicillin 61 59(96.7%) 0 2(3.3%) Vancomycin 64 63(98.4%) 0 1(1.6%)
MB0003 Salmonella Group D Ampicillin 64 64(100%) 0 NA SXT 60 60(100%) 0 NA
MB0004 P. vulgaris Cephalothin 59 35(59.3%) 24(40.7%) NA
Gentamicin 66 65(98.5%) NA 1(1.5%)
*NA: not applicable
Table 4-2. Performance on the automated or Etest antibiotic susceptibility tests ( g/ml) of bacteria distributed for External Quality Assessment of Clinical Microbiology Laboratory in 2000
Specimennumber
Microorganisms and antibiotics
No. oflab Good
Not Acceptable
less thanlower limit
more thanupper limit
MB0005 S. aureus Oxacillin 59 59(100%) 0 0 Vancomycin 65 65(100%) 0
0MB0006 S. aureus
Oxacillin 63 62(98.4%) 0 1(1.6%) Vancomycin 65 64(98.5%) 0 1(1.5%)
MB0007 E. faecalis Ampicillin 67 63(96.0%) 0 4(6.0%)
Vancomycin 70 68(97.1%) 0 2(2.9%)
*NA: not applicable
Table 4-3. Performance on the automated or Etest antibiotic susceptibility tests ( g/ml) of bacteria distributed for External Quality Assessment of Clinical Microbiology Laboratory in 2000
Specimennumber
Microorganisms and antibiotics
No. oflab Good
Not Acceptable
less thanlower limit
more thanupper limit
MB0008 E. coli Ampicillin 66 64(97.0%)
0 2(3.0%) Gentamicin 60 54(90.0%)
0 6(10.0%)MB0009 P. aeruginosa
Piperacillin 65 62(95.4%) 0 3(4.6%)
Gentamicin 65 59(90.8%) 0 6(9.2%)MB0010 K. pneumoniae
Cefotaxime 65 65(100%) 0 0
Imipenem 67 67(100%)
0 0
0
10
20
30
40
50
60
6 8 10 12 14 16 18 20 22 24 26
MB0002MB0007
E. faecalis (ATCC 29212), Vancomycin
Unacceptable: MB0002 - 38.2% (65/170)
MB0007 - 32.4% (56/173)
계속하여 vancomycin 억제대를 작게 보고한 기관
S. aureus: 28 기관 ( 미흡 51 기관 중 54.9%)
E. faecalis: 36 기관 ( 미흡 56 기관 중 64.3%)
Both: 27 기관 ( 총 173 기관 중 15.6%)
Vancomycin (30g) 기준 R I SR I S Staphylococcus Staphylococcus spp. spp.
15 (mm)15 (mm)14mm14mm 이하이하 : : MICMIC 를 측정한다를 측정한다 ..
Enterococcus spp. Enterococcus spp.
14 15-16 14 15-16 17 (mm)17 (mm)
NCCLS M100-S10, 2000
Oxacillin (1g) 기준
R I SR I S S. aureusS. aureus 10 11-12 10 11-12 13 (mm)13 (mm)
Coagulase-negative staphylococci Coagulase-negative staphylococci
17 17 18 (mm)18 (mm)
NCCLS M100-S10, 2000
Ampicillin (10g) 기준
R SR S Enterobacteriaceae Enterobacteriaceae 13 13 17 17
(mm)(mm)
Staphylococci Staphylococci 28 28 2929
Enterococci Enterococci 16 16 1717NCCLS M100-S10, 2000
MB0010
Klebsiella pneumoniae ATCC700603
Positive control strain for extended-spectrum -lactamase
Cefotaxime disk 27mm
Ceftazidime disk 22mm
Aztreonam disk 27mm
Cefpodoxime disk 22mm
ESBL-producing E. coli & Klebsiella
Criteria Susceptible ESBL test Criteria Susceptible ESBL test
Cefotaxime Cefotaxime 23 23 27 mm 27 mm Ceftazidime Ceftazidime 18 18 22 22 Aztreonam Aztreonam 22 22 27 27 Cefpodoxime Cefpodoxime 21 21 22 22 Ceftriaxone Ceftriaxone 21 21 25 25
NCCLS M2-A7, 2000
Double disk synergy test; ESBL
Amoxicillin/Clavulanic acidCefotaxime
Ceftazidime
Aztreonam
Salmonella spp.
Shigella sonnei
Effective -lactams for ESBL
CarbapenemsCarbapenemsImipenem, meropenemImipenem, meropenem
CephamycinsCephamycinsCefotetan, cefoxitin, cefmetazoleCefotetan, cefoxitin, cefmetazole
Anti-Anti-PseudomonasPseudomonas (4 (4 세대세대 ) ) cephalosporinscephalosporinsCefepime, cefpiromeCefepime, cefpirome
-lactamase inhibitor-lactamase inhibitorPiperacillin/tazobactamPiperacillin/tazobactam