1 감염관리를위한진단검사 Laboratory Tests for Infection Control 김수현 전남의대진단검사의학교실
2 강의목표 Understand the importance of the microbiology laboratory to infection control, the infection control nurse, and the infectious disease physician. Understand the various techniques available to assist in an epidemiological investigation and diagnosis of infectious disease. Specimen collection Blood culture Identification of healthcare-associated pathogens Susceptibility testing of healthcare-associated pathogens
3 Infection control team 감시예방교육 Infection 감염병진단치료 Infection physician Control Laboratory 미생물검사면역혈청검사분자생물학검사역학검사
4 Infection physician and infection control team needs answers to 3 very basic questions from the laboratory Is my patient s illness caused by a microbe? Isolation of microbe What is it? Accurate identification What is the susceptibility profile of the organism so therapy can be targeted? Antibiotic susceptibility testing
16 New Guideline on Lab Tests Specific Principles of Specimen Management-1 검체거절기준 : To avoid compromising test results, specimens of poor quality must be rejected. 임상적의의 : Physicians should not request a report of "everything tha t grows," as irrelevant information could lead to inaccurate diagnosis and inappropriate therapy. 적절한채취 : Careful collection is essential to avoid specimen contami nation from normal microbiota.
17 New Guideline on Lab Tests Specific Principles of Specimen Management -2 적당량 : A specimen swab may contain insufficient material to ensure accurate diagnosis and is easily contaminated. 항생제치료전 : Specimens should be collected before starting antibiotics to avoid compromising culture results. 적절한항생제감수성검사 : Susceptibility testing should be limited to clinically significant isolates. 구체적정보 : Complete and accurate specimen labelling is required (eg, dog bite wound, right forefinger).
20 임상미생물검사의종류 민감도특이도 TAT 비용 특수장비, 인력 직접검사법 low (>10 5 ) low high low No Gram stain AFB stain Antigen test M H H M N Antibody test M M L M N 면역혈청법 배양법 H (> ) H L M Y 배지 ( 선택 / 비선택 ) 증균배지 H (< ) 분자유전학적검사법 H (> ) H H H Y PCR PCR-hybridization
26 Immunoassay: QuantiFERON test Persons with latent TB infection (LTBI) are Asymptomatic Not infectious LTBI formerly diagnosed only with TST Now QFT-G can be used
27 ' 결핵안심국가실행계획 고교 1 학년과만 40 세의일반인은모두내년부터건강검진을받을때잠복결핵검사무료 인터페론감마분비검사 IGRA 투베르쿨린피부반응검사 TST 항원 3 proteins from M. tuberculosis Purified protein derivative (PPD) Cell-mediated immune (CMI) In vivo delayed-type hypersensitivity (type IV) 장점잠복결핵진단민감도 92%, 특이도 99% 축적된임상자료많음 BCG 접종, NTM 위양성없음 채혈 1 회 재검사시증폭효과없음 체외검사로이상반응우려없음 체내검사검사오류적음 위험도예측 경제적 단점비쌈 BCG, NTM 위양성, 낮은특이도 림프구생명력유지, 정량채혈 장비, 인력소요 소아자료부족, 위음성 재방문, 재검사시증폭효과 체내검사로이상반응우려 주관적, 정도관리어려움
28 Osong Public Health Res Perspect Dec; 5(Suppl): S24 S29.
29 국내 real-time PCR TB/NTM kits 평가 Anyplex plus (71.0%, 94.9%) AdvanSure (78.1% 와 93.9%) Ann Clin Microbiol Vol. 18, No. 2, June, 2015
30 Table 2. Diagnostic accuracy of the Xpert MTB/RIF assay using sputum specimens for the diagnosis of pulmonary tuberculosis (Bacteriologically confirmed cases). Kwak N, Choi SM, Lee J, Park YS, Lee CH, et al. (2013) Diagnostic Accuracy and Turnaround Time of the Xpert MTB/RIF Assay in Routine Clinical Practice. PLoS ONE 8(10): e doi: /journal.pone
31 Table 5. Turnaround time of the Xpert MTB/RIF, AFB smear, liquid/solid culture and drug susceptibility test. Kwak N, Choi SM, Lee J, Park YS, Lee CH, et al. (2013) Diagnostic Accuracy and Turnaround Time of the Xpert MTB/RIF Assay in Routine Clinical Practice. PLoS ONE 8(10): e doi: /journal.pone
32 Clinical Microbiology Is a Science of Interpretive Judgment 임상적의의와적절한검체채취 정확한동정과감수성검사 신속한진단검사 감염관련통계등정보제공 의료인, 환경배양 미생물검사에대한전문적인해석, 미생물학적조치에대한조언, 필요한검사제공, 의료관련감염균동정법에대한장단점등기술적조언 감사합니다!