Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Recovery Rate and Characteristics of Nontuberculous Mycobacterial Isolates in a University Hospital in Korea

한 대학병원에서 비결핵항산균의 분리 및 동정 실태

  • Lee, Jung Yeon (Division of Pulmonary and Critical Care Medicine University of Ulsan College of Medicine, Asan Medical Center) ;
  • Choi, Hee Jin (University of Ulsan College of Medicine, Asan Medical Center, Asan Institute for Life Sciences) ;
  • Lee, Hyeyoung (Department of Biomedical Laboratory Science, Yonsei University Wonju College of Medicine) ;
  • Joung, Eun Young (Product Planning and Development Dept. M&D Co., LTD.) ;
  • Huh, Jin Won (Division of Pulmonary and Critical Care Medicine University of Ulsan College of Medicine, Asan Medical Center) ;
  • Oh, Yeon-Mok (Division of Pulmonary and Critical Care Medicine University of Ulsan College of Medicine, Asan Medical Center) ;
  • Lee, Sang Do (Division of Pulmonary and Critical Care Medicine University of Ulsan College of Medicine, Asan Medical Center) ;
  • Kim, Woo Sung (Division of Pulmonary and Critical Care Medicine University of Ulsan College of Medicine, Asan Medical Center) ;
  • Kim, Dong Soon (Division of Pulmonary and Critical Care Medicine University of Ulsan College of Medicine, Asan Medical Center) ;
  • Kim, Won Dong (Division of Pulmonary and Critical Care Medicine University of Ulsan College of Medicine, Asan Medical Center) ;
  • Shim, Tae Sun (Division of Pulmonary and Critical Care Medicine University of Ulsan College of Medicine, Asan Medical Center)
  • 이정연 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 최희진 (울산대학교 의과대학 서울아산병원 아산생명과학연구소) ;
  • 이혜영 (연세대학교 원주의과대학 보건과학대학 임상병리학과) ;
  • 정은영 ((주)엠엔디 연구개발부) ;
  • 허진원 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 오연목 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 이상도 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 김우성 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 김동순 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 김원동 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 심태선 (울산대학교 의과대학 서울아산병원 호흡기내과)
  • Received : 2004.10.27
  • Accepted : 2005.02.04
  • Published : 2005.04.30
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Abstract

Background : The incidence of nontuberculous mycobacterium (NTM) infections in Korea is increasing. This retrospective study was performed to examine the recovery rate of NTM from respiratory specimens as well as the isolated NTM colony characteristics, and to assess the clinical significance of a NTM isolation. Methods : The results of the respiratory specimens requested for an acid-fast bacilli (AFB) examination during 2002 at Asan Medical Center, along with the patients clinical characteristics were analyzed. Results : A total 26,820 respiratory specimens were requested for the acid-fast bacilli (AFB) smear and culture during the study period. The proportion of M. tuberculosis and NTM isolation was 5.7% and 2.2%, respectively. Among the AFB smear and culture positive specimens, 12.2% were found to be NTM. The scotochromogen showing a low colony count < 20, which appeared to be contaminants, were isolated in 31.8% of the 584 NTM isolates. Excluding the low-colony scotochromogens, the M. avium-intracellulare complex was the most common NTM isolates (42.1%), and was also the most common causative organism for NTM pulmonary diseases. 8.4% (23/275) and 17.8% (49/275) of patients with NTM isolates met the American and British Thoracic Society diagnostic criteria for NTM pulmonary disease, respectively. Conclusion : In case of a positive AFB-smear or culture result, the possibility of NTM being a causative organism should always be considered, even in Korea, which has an intermediate incidence of tuberculosis.

연구배경 : 최근 국내에서도 NTM 분리율 및 감염 빈도가 증가하고 있는 추세이다. 본 연구는 국내 한 삼차의료기관에서 1년 동안 항산균 검사가 의뢰된 호흡기 검체에서 NTM의 배양양상 및 분리비율을 살펴보고 그 임상적 의의에 대해 알아보고자 하였다. 방 법 : 2002년 1년간 서울아산병원에서 미생물검사실로 항산균 검사가 의뢰된 호흡기 검체를 대상으로 도말, 배양 및 동정 결과를 확인하고 그 임상적 의의를 분석하였다. 결 과 : 총 9,821명의 환자에서 26,820건의 항산균검사가 시행되었다. 결핵균이 동정 된 건수와 환자수의 비율은 각각 5.7%, 6.3%였고, 비결핵항산균은 각각 2.2%, 2.8% 이었다. 도말양성, 배양양성 중 결핵균 및 NTM의 비율은 각각 87.8%, 12.2%이었다. NTM 중 오염의 가능성이 높은 암색소성-저집락군은 31.8%(186/584 균주)에서 분리되었다. 암색소성-저집락군을 제외한 NTM 중 MAC, M. fortuitum complex의 분리비율이 42.1%(138/328), 19.5%(64/328)로 가장 높았다. 암색소성-저집락군을 제외한 NTM이 분리된 275명 중 미국 및 영국 흉부학회 진단기준을 만족하는 NTM 폐질환은 각각 8.4%(23명), 17.8%(49명)이었다. 결 론 : 국내 한 대학병원에서의 항산균 검사 결과 NTM의 분리 비율이 높고 일부는 NTM 폐질환의 원인이어서 항산균 도말 및 배양 양성의 경우 국내에서도 반드시 NTM의 가능성을 고려하여야 하겠다.

Keywords

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