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제1장 서론 11

제2장 연구 재료 및 방법 13

제1절 연구 재료 13

제2절 연구 방법 14

1. 혈액 배양 14

2. 진균 동정 15

3. 항진균제 감수성 시험 16

4. 통계분석 18

제3장 결과 19

제1절 연도별 진균 분리율 19

제2절 연도별 균종 분리 빈도 21

제3절 전기(2009-13년)와 후기(2014-8년)의 분리 빈도 비교 24

제4절 환자의 연령 군별 분리 균종의 빈도 26

제5절 환자의 성별로 분리된 균종의 빈도 28

제6절 환자의 병동별 분리 균종 빈도 30

제7절 항진균제 감수성 시험 결과 32

1. C. albicans의 항진균제 감수성 시험 결과 35

2. C. glabrata의 항진균제 감수성 시험 결과 37

3. C. krusei의 항진균제 감수성 시험 결과 39

4. C. parapsilosis의 항진균제 감수성 시험 결과 42

5. C. tropicalis의 항진균제 감수성 시험 결과 44

6. 통계 분석 결과 46

제4장 고찰 49

제5장 결론 56

참고문헌 57

ABSTRACT 65

표목차

Table 1. Interpretation guidelines for antibiotic susceptibility tests of... 17

Table 2. Numerical data positive rate on bacteria and fungi that were... 20

Table 3. Comparison of the number of specimens and patients by Candida... 22

Table 4. Distribution of 3,533 Candida species isolated from 1,054... 25

Table 5. Isolation rate of Candida species by age group of patients. 27

Table 6. Isolation rate of Candida species by gender in patients. 29

Table 7. The result of antifungal agents susceptibility test of Candida spp.... 31

Table 8. Antirungal susceptibility frequency or all Candida species strains... 33

Table 9. Antifungal resistance patterns of Candida albicans isolated from... 36

Table 10. Antifungal resistance patterns of Candida glabrata isolated from... 38

Table 11. Antifungal resistance patterns of Candida krusei isolated from... 40

Table 12. Antifungal intermediate (SDD) patterns of Candida krusei... 41

Table 13. Antifungal resistance patterns of Candida parapsilosis isolated... 43

Table 14. Antifungal resistance patterns of Candida tropicalis isolated... 45

Table 15. Significant difference between fluconazole and voriconazole... 47

Table 16. Significant difference between fluconazole and voriconazole... 48

그림목차

Fig. 1. Isolation rate of Candida spp. isolated from blood cultures in... 23

Fig. 2. Isolation rate by year of Candida spp. isolated from blood cultures... 23

Fig. 3. Antifungal resistance rates of Candida species isolated from blood... 33

Fig. 4. Antifungal resistance ratio of all Candida species isolated from... 34

초록보기

Background: Bloodstream infections (BSI) are critical infectious diseases, and the number of cases emerging due to Candida species has been increasing constantly. Since the trends in the isolation rate and antifungal susceptibility of Candida species vary depending on time, region, and subject, analyses of these factors will provide important data for establishing treatment of patients and a basis for establishing a more robust treatment regimen. This study conducted a retrospective analysis based on the isolation rate and antifungal susceptibility of Candida species cultured in blood samples for 10 years in a tertiary hospital.

Method: The blood sAMBles of patients whose blood was cultured between 2009 and 2018 were injected into the aerobic and anaerobic culture bottles, and cultured for 5 days in BacT/Alert 3D(bioMérieux Inc. Durham, NC, USA). Fungal species present in these cultures were identified using Vitek 2 YST(bioMerieux, Marcy l'Etoile, France) and Vitek MS(bioMerieux, Marcy l'Etoile, France). Antifungal susceptibility was tested using Vitek-2 YS07(bioMerieux, Marcy l'Etoile, France). For each patient, only the first isolated fungal strain was included in the analysis.

Results: In this study, there were 54,739 positive cases identified among 717,996 blood cultures, and the fungal isolation rate was 3,533 cases (6.5%) in 1,036 patients. The species distribution was as follows: C. albicans, 33.2% (n＝350); C. tropicalis, 28.1% (n＝296); C. glabrata, 19.7% (n＝208); C. parapsilosis, 7.7% (n＝81); and C. krusei, 4.2% (n＝44). Among 932 strains tested for susceptibility to fluconazole, 4.7% (n＝44) exhibited resistance. Among 947 strains tested for susceptibility to amphotericin B, 0.6% (n＝6) exhibited resistance. Among 973 strains tested for susceptibility to flucytosine, 2.4% (n＝23) exhibited resistance. Among 768 strains tested for susceptibility to voriconazole, 3.1% (n＝24) exhibited resistance.

Conclusion: While C. albicans remains the most frequently isolated species, the difference in its isolation frequency from non-albicans Candida species species is decreasing. The susceptibility of Candida species to fluconazole and voriconazole showed a decreasing trend, and possibly, a large number of resistant strains of C. krusei could appear in the future. As the number of strains resistant to antifungal agents is gradually increasing, strict management of the use of antifungal agents is of utmost importance. Furthermore, monitoring activities, including periodic investigations to track resistance, and thorough hospital infection control activities are required.

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