Annals of Laboratory Medicine

Korean Society for Laboratory Medicine (대한진단검사의학회)
권호 표지
DOI QR코드

DOI QR Code

Species Distribution and Antifungal Susceptibilities of Yeast Clinical Isolates from Three Hospitals in Korea, 2001 to 2007

  • Lee, Mi-Kyung (Department of Laboratory Medicine, Chung-Ang University College of Medicine) ;
  • Yong, Dong-Eun (Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine) ;
  • Kim, Myung-Sook (Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine) ;
  • Kim, Mi-Na (Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center) ;
  • Lee, Kyung-Won (Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine)
  • Received : 2010.01.15
  • Accepted : 2010.07.12
  • Published : 2010.08.31
⟨ Previous Next ⟩

Abstract

Background : We utilized results from the ARTEMIS DISK Global Antifungal Surveillance Program to evaluate the species distribution and fluconazole and voriconazole susceptibilities of yeast isolates from clinical specimens in South Korea from 2001 to 2007. Methods : Data were collected on 5,665 yeast isolates from all body sites at three locations. All investigators tested clinical yeast isolates using the CLSI M44-A disk diffusion method. Test plates were automatically read and results were recorded using the BIOMIC image analysis plate reader system (Giles Scientific, USA). Species, drug, zone diameter, susceptibility category, and quality control results were collected quarterly via e-mail for analysis. Results: Candida albicans was the most common isolate, but a progressive increase in non-C. albicans Candida and noncandidal yeast species has been observed in recent years. The overall percentages of isolates in each category (susceptible, susceptible dose dependent, and resistant) were 98.8%, 0.5%, and 0.7% and 99.2%, 0.2%, and 0.6% for fluconazole and voriconazole, respectively. Candida of 3 species exhibited decreased susceptibility to fluconazole (<90% S) in the order of that seen with the resistant (R) species: C. krusei, C. guilliermondii, and C. glabrata. Emerging resistance to fluconazole or voriconazole was documented among isolates of Cryptococcus neoformans, Trichosporon spp., and Rhodotorula spp. Conclusions : The species distribution and antifungal susceptibilities of yeasts may differ according to specimen type, testing method, hospital, and geographic region. Therefore, further largescaled, long-term surveillance studies are needed to isolate yeasts and to confirm the species distribution and antifungal susceptibilities of yeast isolates from clinical specimens in Korea.

배경 : 본 연구에서는 2001년부터 2007년까지 ARTEMIS DISK Global Antifungal Surveillance Program에 참여하여 얻은 결과를 이용하여, 국내 임상 검체에서 분리된 효모의 균종분포와 fluconazole과 voriconazole에 대한 감수성 양상을 분석하였다. 방법 : 국내 3개 병원의 각종 임상검체에서 분리된 5,665 균주의 효모에서 자료를 수집하였다. 감수성 검사는 CLSI M44-A에 근거하여 디스크확산법으로 시행하였다. 결과는 BIOMIC image analysis plate reader system (Giles Scientific, USA)을 사용하여 판독하였다. 결과 분석을 위하여 균종명, 약제, 억제대 지름, 카테고리에 의한 감수성 결과, 정도관리 결과 등을 전자 메일을 사용하여 전송하였다. 결과 : Candida albicans가 가장 흔히 분리되었으며, 최근 non-C. albicans 칸디다와 칸디다 이외 효모의 증가를 보이고 있다. 효모의 fluconazole과 voriconazole에 대한 감수성 결과는 각각 98.8%와 99.2% (감수성), 0.5%와 0.2% (약용량 의존감수성), 0.7%와 0.6% (내성)였다. Candida krusei, Candida guilliermondii 및 Candida glabrata 3 균종의 칸디다에서 fluconazole 내성이 검출되어 fluconazole에 대한 감수성이 감소한 것으로 조사되었다(<90% 감수성). Fluconazole이나 voriconazole에 내성이 검출된 균종은 Cryptococcus neoformans, Trichosporon spp.와 Rhodotorula spp.였다. 결론 : 효모의 균종 분포와 항진균제 감수성은 검체 종류, 사용하는 검사법, 병원, 지역에 따라 다를 수 있기 때문에, 국내에서 분리되는 효모의 균종 분포와 항진균제 감수성을 평가하기 위한 대규모의 장기간 감시 연구가 필요할 것으로 생각된다.

Keywords

References

  1. Chae MJ, Shin JH, Cho D, Kee SJ, Kim SH, Shin MG, et al. Antifungal susceptibilities and distribution of Candida species recovered from blood cultures over an 8-yr period. Korean J Lab Med 2003; 23:329-35. (채명종, 신종희, 조덕, 기승정, 김수현, 신명근 등. 최근 8 년간 혈액에서 분리된 Candida 균종과 항진균제 감수성. 대한진단 검사의학회지 2003;23:329-35.)
  2. Shin JH, Kim HR, Lee JN. Distribution and antifungal susceptibility of Candida species isolated from clinical specimens during the past six years. Korean J Clin Microbiol 2004;7:164-70. (신정환, 김혜란, 이정녀. 최근 6년간 임상검체에서 분리된 칸디다의 균종 분포와 항진균제 감수성. 대한임상미생물학회지 2004;7:164-70.)
  3. Lee MK, Kim HR, Kang JO, Kim MN, Kim EC, Kim JS, et al. Susceptibility and trailing growth of Candida albicans to fluconazole: results of a Korean multicentre study. Mycoses 2007;50:148-9. https://doi.org/10.1111/j.1439-0507.2006.01329.x
  4. Lee JS, Shin JH, Lee K, Kim MN, Shin BM, Uh Y, et al. Species distribution and susceptibility to azole antifungals of Candida bloodstream isolates from eight university hospitals in Korea. Yonsei Med J 2007;48:779-86. https://doi.org/10.3349/ymj.2007.48.5.779
  5. Kim SH, Shin JH, Kim EC, Lee K, Kim MN, Lee WG, et al. The relationship between antifungal usage and antifungal susceptibility in clinical isolates of Candida: a multicenter Korean study. Med Mycol 2009;47:296-304. https://doi.org/10.1080/13693780802291445
  6. Yoo JI, Choi CW, Lee KM, Kim YK, Kim TU, Kim EC, et al. National surveillance of antifungal susceptibility of Candida species in South Korean hospitals. Med Mycol 2009;47:554-8. https://doi.org/10.1080/13693780802354037
  7. Pfaller MA, Diekema DJ, Rinaldi MG, Barnes R, Hu B, Veselov AV, et al. Results from the ARTEMIS DISK Global Antifungal Surveillance Study: a 6.5-yr analysis of susceptibilities of Candida and other yeast species to fluconazole and voriconazole by standardized disk diffusion testing. J Clin Microbiol 2005;43:5848-59. https://doi.org/10.1128/JCM.43.12.5848-5859.2005
  8. Pfaller MA, Diekema DJ, Gibbs DL, Newell VA, Meis JF, Gould IM, et al. Results from the ARTEMIS DISK Global Antifungal Surveillance Study, 1997 to 2005: an 8.5-yr analysis of susceptibilities of Candida species and other yeast species to fluconazole and voriconazole determined by CLSI standardized disk diffusion testing. J Clin Microbiol 2007;45:1735-45. https://doi.org/10.1128/JCM.00409-07
  9. Pfaller MA, Diekema DJ, Gibbs DL, Newell VA, Bijie H, Dzierzanowska D, et al. Results from the ARTEMIS DISK Global Antifungal Surveillance Study, 1997 to 2007: 10.5-yr analysis of susceptibilities of noncandidal yeast species to fluconazole and voriconazole determined by CLSI standardized disk diffusion testing. J Clin Microbiol 2009;47:117-23. https://doi.org/10.1128/JCM.01747-08
  10. Isenberg HD. Clinical microbiology procedures handbook. 2nd ed. Washington, DC: ASM Press, 2003:3.11.2.
  11. Sheehan DJ; National Committee for Clinical Laboratory Standards. Method for antifungal disk diffusion susceptibility testing of yeasts: approved guideline. M44-A. Wayne, PA: NCCLS, 2004.
  12. Hazen KC, Baron EJ, Colombo AL, Girmenia C, Sanchez-Sousa A, del Palacio A, et al. Comparison of the susceptibilities of Candida spp. to fluconazole and voriconazole in a 4-yr global evaluation using disk diffusion. J Clin Microbiol 2003;41:5623-32. https://doi.org/10.1128/JCM.41.12.5623-5632.2003
  13. Kang BK, Lee HJ, Suh JT. The Trends of the species and antimicrobial susceptibility of bacteria and fungi isolated from blood cultures (1986-1996). Korean J Clin Pathol 1998;18:57-64. (강병기, 이희 주, 서진태. 혈액에서 배양된 세균과 진균의 균종 및 항균제 감수성의 추이 (1986-1996). 대한임상병리학회지 1998;18:57-64.)
  14. Uh Y, Jang IH, Yoon KJ, Kim HY. Isolation trend and antifungal susceptibility of Candida species isolated from blood cultures. Korean J Infect Dis 2001;33:186-93. (어영, 장인호, 윤갑준, 김효열. 최근 혈액에서 분리되는 칸디다 균종의 분리추이와 항진균제 감수성. 감 염 2001;33:186-93.)
  15. Kim YA, Cho DH, Lee K, Chong Y, Kwon HK. Yeasts isolated from oral cavity of the healthy adults. Korean J Clin Pathol 2000; 20:30-5. (김영아, 조동희, 이경원, 정윤섭, 권호근. 건강 성인의 구강 에서 분리되는 효모형 진균. 대한임상병리학회지 2000;20:30-5.)
  16. Lee SH, Kim SW, Bang YJ. A study on the distribution of oral candidal isolates in diabetics. Korean J Med Mycol 2002;7:139-48. (이시헌, 김상원, 방용준. 당뇨환자에서 구강내 칸디다균의 분포에 대한 조사. 대한의진균학회지 2002;7:139-48.)
  17. Choi JH, Suh MK, Ha GY. Isolation and identification of Candida species in superficial cutaneous candidiasis. Korean J Dermatol 2002;40:1188-94. (최진혁, 서무규, 하경임. 표재성 피부칸디다증에서 칸디다 균종의 분리 및 동정. 대한피부과학회지 2002;40:1188-94.)
  18. Pfaller MA, Hazen KC, Messer SA, Boyken L, Tendolkar S, Hollis RJ, et al. Comparison of results of fluconazole disk diffusion testing for Candida species with results from a central reference laboratory in the ARTEMIS global antifungal surveillance program. J Clin Microbiol 2004;42:3607-12. https://doi.org/10.1128/JCM.42.8.3607-3612.2004
  19. Pfaller MA, Boyken L, Hollis RJ, Kroeger J, Messer SA, Tendolkar S, et al. Comparison of results of fluconazole and voriconazole disk diffusion testing for Candida spp. with results from a central reference laboratory in the ARTEMIS DISK Global Antifungal Surveillance Program. Diagn Microbiol Infect Dis 2009;65:27-34. https://doi.org/10.1016/j.diagmicrobio.2009.05.007

Cited by

  1. Distribution of Yeast and Mold Species Isolated from Clinical Specimens at 12 Hospitals in Korea during 2011 vol.16, pp.2, 2013, https://doi.org/10.5145/acm.2013.16.2.92
  2. Misidentification of Candida guilliermondii as C. famata among Strains Isolated from Blood Cultures by the VITEK 2 System vol.2014, pp.None, 2010, https://doi.org/10.1155/2014/250408
  3. Identification of Uncommon Candida Species Using Commercial Identification Systems vol.26, pp.12, 2016, https://doi.org/10.4014/jmb.1609.09012
  4. Isolation frequency and epidemiological characterization of yeast-like fungi and co-infected bacteria isolated from clinical patient vol.7, pp.2, 2016, https://doi.org/10.5897/jyfr2015.0160