비임균성비뇨생식기감염에서 의진단적효용성 Usefulness of the Mycofast Test (MYCOFAST Evolution 2) for the Diagnosis of Nongonococcal Genitourinary Infections Hang Ro Park, Yang Hyun Kim, Ho Jae Lee, Jea Sang Oh, Hyoung Jin Kim From the Department of Urology, Sung Ae General Hospital, Seoul, Korea Purpose: We wanted to investigate the usefulness of Mycofast (MYCOFAST Evolution 2, International Microbio, France) for Ureaplasma urealyticum (U. urealyticum) and Mycoplasma hominis (M. hominis) in association with nongonococcal genitourinary infections. Materials and Methods: 530 patients visited our department for genitourinary infection symptoms or for the evaluation of sexually transmitted disease. The genital swabs were first vortexed in Mycofast transport broth. A volume of 100 l of liquid sample was innoculated to each well of the Mycofast broths and 0.5 l of liquid sample was innoculated to A7 agar culture media (International Microbio, France). The Mycofast broths were incubated at 35-37 o C for 36 hrs, and the A7 agar culture media was incubated for 4 days. We compaired Mycofast with A7 agar culture for the sensitivity, specificity, the positive and negative predictive values and the antibiotic susceptable profiles. Results: Of the 530 samples submitted, 165 samples were positive by the A7 agar culture and 162 samples were positive by Mycofast. 157 samples were positive by both methods. Of the 365 samples that were negative by the A7 agar culture, 360 samples were also negative by the Mycofast. In this study, Mycofast had a sensitivity and specificity of 95% and 98%, respectively, and a positive and negative predictive value of 96% and 97%, respectively. The Mycofast drug susceptibility tests indicate a high susceptibility to doxycyclin as follows: U. urealyticum: 86.3%; M. hominis: 85.0% and both organisms with simultaneous isolation: 75.8%. Conclusions: Mycofast was an easy test to perform and it proved to be a practical and reliable method for isolating the Mycoplasma and Ureaplasma species for making the diagnosis of nongonococcal genitourinary infections, and it showed the added benefit of determining the limited susceptibilities of the isolated strains. (Korean J Urol 2006;47:1117-1123) Key Words: Ureaplasma urealyticum, Mycoplasma hominis, Diagnosis
박항로 외 비임균성 비뇨생식기 감염에서 Mycofast Test (MYCOFAST Evolution 2)의 진단적 효용성 1119 다. M. hominis의 집락은 이와 같은 변화가 없으므로 감별이 결 가능하다. 또한 성게모양의 특징적인 집락모양 또한 감별 점이 될 수 있다 (Fig. 3). o Mycofast tray는 35 C에서 36시간, A7 agar culture medium 과 1. 환자군의 분석 은 4일 동안 배양한 후, 각각의 변화를 관찰 비교하고, 각각 환자의 평균 연령은 U. urealyticum 음성군이 39.5세, 양성 의 민감도와 특이도, 양성, 음성 예측률을 알아보았고, 항생 군이 40.0세였으며, M. hominis 음성군이 39.1세, 양성군이 제의 감수성 및 내성에 대한 검사로써 doxycycline, roxythro- 39.7세로 두 균주 각각 양 군 간에 연령 차이를 보이지 않았 mycin, ofloxacin의 세 가지 약제에 대한 drug susceptable 다. U. urealyticum과 M. hominis 양성 및 음성군 모두에서 profile을 구하였다. 한편, 항생제 감수성검사 결과에 기초한 20-44%의 흡연의 경험이나 현재 흡연을 하고 있었으며, 나 2주 간격의 약물치료 후 환자의 증상소실 여부와 Mycofast 이분포에 따른 두 균주의 음성군과 양성군의 경우 양측 모 를 재검하여 균의 음성전환 여부를 알아보았다. 결과분석 두에서, 남성은 30대, 여성은 40대가 가장 많이 차지하였다. 을 위한 통계처리는 SPSS프로그램 (version 12.0)을 사용하 Mycofast 양성군에서 남성은 55례, 여성은 107례였고, My- 였고, 과거력과 Mycofast 양성과의 관계는 상관분석을 이용 cofast와 A7 agar culture에서 동시에 양성으로 나타난 157례 하였다. 중 성별에 따른 균주의 빈도를 살펴보면 남, 녀 각각 69.6%, 46.0%로 U. urealyticum이 가장 많은 빈도를 나타냈다 (Table Enumeration U. urealyticum Antibiotic resistance testing Identification Enumeration M. hominis Fig. 1. Detection of Ureaplasma urealyticum and Ureaplasma 4 urealyticum at 10 CCUs (color change units) mycofast/ml, as diagnosed by the color change of the enumeration and identification well on the MYCOFAST Evolution 2 tray. A Fig. 2. MYCOFAST Evolution 2 tray. The tray is consisted of 10 wells. B C Fig. 3. (A) The microscopic finding of Ureaplasma urealyticum in the A7 agar culture medium. The colonies show a brown or black urchin-like appearance. (B) The microscopic finding of Mycoplasma hominis in the A7 agar culture medium. The colonies have a characteristic fried egg appearance. (C) The microscopic finding of Ureaplasma urealyticum and Mycoplasma hominis as cultured simultaneously in A7 agar culture medium.