1. 김의종(집필대표), 강정옥, 김미나, 김민중, 김성일, 이경원, 이도현, 이장호, 이남용, 이창규, 신종희, 장철훈, 최혜심
임상미생물검사 신빙도 조사 결과보고(2000)
대한임상검사정도관리협회 임상미생물분과위원회
김의종(집필대표), 강정옥, 김미나, 김민중, 김성일, 이경원, 이도현, 이장호, 이남용, 이창규, 신종희, 장철훈, 최혜심

2. Table 1. Microorganisms distributed for External Quality Assessment of
Clinical Microbiology Laboratory in 2000
Specimen
number
Trial
Microorganism
Source
MB0001
MB0002
MB0003
MB0004
MB0005
Klebsiella oxytoca
Enterococcus faecalis
Salmonella spp. Group D
Proteus vulgaris
Staphylococcus aureus
Clinical isolate
ATCC 29212
ATCC 49132
ATCC 25923 I
MB0006
MB0007
MB0008
MB0009
MB0010
Staphylococcus aureus
Enterococcus faecalis
E. coli
Pseudomonas aeruginosa
Klebsiella pneumoniae
ATCC 25923
ATCC 29212
ATCC 25922
ATCC 27853
ATCC II

3. No. of laboratories indicated
Table 2. Performance on the identification of microorganisms distributed
for External Quality Assessment of Clinical Microbiology Laboratory in 2000
No. of laboratories indicated
level of performance
Specimen
Number
No. of
laboratories
Microorganisms
Not
acceptable
Good Acceptable
MB0001
MB0002
MB0003
MB0004
MB0005
MB0006
MB0007
MB0008
MB0009
MB0010
Klebsiella oxytoca
Enterococcus faecalis
Salmonella spp. Group D
Proteus vulgaris
Staphylococcus aureus
E. coli
Pseudomonas aeruginosa
Klebsiella pneumoniae
217
225
209
154
151
213
217
175
223
222 - 40 47 1 35 9 8 23 19 7 4 15 2 3

4. Not acceptable for the identification
Enterococcus faecalis
MB % (23/217)
MB % (15/225)
Salmonella spp. Group D
8.8% (19/217)

5. Catalase-negative, gram-positive cocci
with bile-esculin-positive
Enterococcus Group D streptococci
6.5% NaCl broth Growth No growth
PYR test
PYR: L-pyrrolidonyl-b-naphthylamide
Group D streptococci: S. bovis, S. equinus

6. Enterococcus spp.
Motility Yellow colony
E. faecalis
E. faecium
E. gallinarum
E. casseliflavus

7. Salmonella spp. MacConkey agar SS agar XLD agar TSI agar: K/Ag+, K/Ag-
Lysine iron agar: K/K+
TSI LIA

8. Table 3-1. Performance on the disk-diffusion antibiotic susceptibility tests (mm) of microorganisms distributed for External Quality Assessment of Clinical Microbiology Laboratory in 2000
Not Acceptable
Specimen
number
Microorganisms
and antibiotics
No. of
lab
less than
lower limit
more than
upper limit
Good
MB K. oxytoca
Cephalothin (94.8%) NA* (5.2%)
Cefotaxime (64.4%) (35.6%) NA
MB E. faecalis
Ampicillin (97.1%) 5(2.9%) NA
Vancomycin (61.8%) 65(38.2%) NA
MB Salmonella Group D
Ampicillin (98.8%) 2(1.2%) NA
SXT (100%) NA
MB P. vulgaris
Cephalothin (60.4%) NA (39.6%)
Gentamicin (98.8%) (1.2%) NA
*NA: not applicable

9. Salmonella, Shigella 항생제 감수성 검사 1세대, 2세대 세팔로스포린은 검사하지 않는다.
Ampicillin
Ciprofloxacin
Trimethoprim/sulfamethoxazole
1세대, 2세대 세팔로스포린은 검사하지 않는다.
장외에서 분리된 Salmonella
Chloramphenicol, cefotaxime 추가

10. Salmonella, Shigella
3세대 세팔로스포린 (ceftriaxone, cefotaxime, cefoperazone 등)에서 중간 (intermediate) 또는 내성으로 나오면, ESBL test를 실시한다.
ESBL: Extended-spectrum -lactamase
거의 모든 세팔로스포린으로 치료되지 않는다.
검사에서 감수성으로 나와도 내성으로 보고한다.
ESBL-Shigella: 세계 최초로 출현!!!!!!
ESBL-Salmonella: 간혹 분리되고 있음

11. Table 3-2. Performance on the disk-diffusion antibiotic susceptibility tests (mm) of microorganisms distributed for External Quality Assessment of Clinical Microbiology Laboratory in 2000
Not Acceptable
Specimen
number
Microorganisms
and antibiotics
No. of
lab
less than
lower limit
more than
upper limit
Good
MB S. aureus
Oxacillin (81.8%) 15(8.8%) 16(9.4%)
Vancomycin (59.4%) 67(38.3%) 4(2.3%)
MB S. aureus
Oxacillin (87.8%) 15(8.7%) 6(3.5%)
Vancomycin (70.7%) 51(28.7%) 1(0.6%)
MB E. faecalis
Ampicillin (98.3%) 3(1.7%) NA
Vancomycin (67.6%) 56(32.4%) NA
*NA: not applicable

12. S. aureus (ATCC 25923), Vancomycin
Unacceptable: MB % (67/175)
MB % (51/178)

13. Staphylococcus spp.에서 vancomycin disk
15 mm 이상이어야 감수성으로 판정하고,
14 mm이하이면 반드시 최소억제농도를 측정하여
4 g/mL이하이면 감수성이며,
4 g/mL보다 크면 내성을 의심해야 한다.

14. Table 3-3. Performance on the disk-diffusion antibiotic susceptibility tests (mm) of microorganisms distributed for External Quality Assessment of Clinical Microbiology Laboratory in 2000
Not Acceptable
Specimen
number
Microorganisms
and antibiotics
No. of
lab
less than
lower limit
more than
upper limit
Good
MB E. coli
Ampicillin (87.7%) 13(7.6%) 8(4.7%)
Gentamicin (86.1%) 11(6.1%) 14(7.8%)
MB P. aeruginosa
Piperacillin (91.9%) 11(8.1%) 0
Gentamicin (79.8%) 2(1.1%) 34(19.1%)
MB K. pneumoniae
Cefotaxime (91.8%) 10(6.8%) 2(1.4%)
Imipenem (98.7%) 2(1.3%) 0

15. Table 4-1. Performance on the automated or Etest antibiotic susceptibility tests ( g/ml) of bacteria distributed for External Quality Assessment of Clinical Microbiology Laboratory in 2000
Not Acceptable
Specimen
number
Microorganisms
and antibiotics
No. of
lab
less than
lower limit
more than
upper limit
Good
MB K. oxytoca
Cephalothin (95.3%) 3(4.7%) NA*
Cefotaxime (96.8%) NA 2(3.2%)
MB E. faecalis
Ampicillin (96.7%) (3.3%)
Vancomycin (98.4%) (1.6%)
MB Salmonella Group D
Ampicillin (100%) NA
SXT (100%) NA
MB P. vulgaris
Cephalothin (59.3%) (40.7%) NA
Gentamicin (98.5%) NA 1(1.5%)
*NA: not applicable

16. Table 4-2. Performance on the automated or Etest antibiotic susceptibility tests ( g/ml) of bacteria distributed for External Quality Assessment of Clinical Microbiology Laboratory in 2000
Not Acceptable
Specimen
number
Microorganisms
and antibiotics
No. of
lab
less than
lower limit
more than
upper limit
Good
MB S. aureus
Oxacillin (100%)
Vancomycin (100%)
MB S. aureus
Oxacillin (98.4%) (1.6%)
Vancomycin (98.5%) (1.5%)
MB E. faecalis
Ampicillin (96.0%) (6.0%)
Vancomycin (97.1%) (2.9%)
*NA: not applicable

17. Table 4-3. Performance on the automated or Etest antibiotic susceptibility tests ( g/ml) of bacteria distributed for External Quality Assessment of Clinical Microbiology Laboratory in 2000
Not Acceptable
Specimen
number
Microorganisms
and antibiotics
No. of
lab
less than
lower limit
more than
upper limit
Good
MB E. coli
Ampicillin (97.0%) (3.0%)
Gentamicin (90.0%) (10.0%)
MB P. aeruginosa
Piperacillin (95.4%) (4.6%)
Gentamicin (90.8%) (9.2%)
MB K. pneumoniae
Cefotaxime (100%)
Imipenem (100%)

18. E. faecalis (ATCC 29212), Vancomycin
Unacceptable: MB % (65/170)
MB % (56/173)

19. 계속하여 vancomycin 억제대를 작게 보고한 기관
S. aureus: 28 기관(미흡 51기관 중 54.9%)
E. faecalis: 36 기관(미흡 56기관 중 64.3%)
Both: 27 기관(총 173기관 중 15.6%)

20. Vancomycin (30g) 기준 R I S Staphylococcus spp. 15 (mm)
14mm이하: MIC를 측정한다.
Enterococcus spp.
 17 (mm)
NCCLS M100-S10, 2000

21. Oxacillin (1g) 기준 R I S S. aureus 10 11-12 13 (mm)
Coagulase-negative staphylococci
 18 (mm)
NCCLS M100-S10, 2000

22. Ampicillin (10g) 기준 R S Enterobacteriaceae 13 17 (mm)
Staphylococci  29
Enterococci  17
NCCLS M100-S10, 2000

23. MB0010
Klebsiella pneumoniae ATCC700603
Positive control strain for extended-spectrum -lactamase
Cefotaxime disk 27mm
Ceftazidime disk 22mm
Aztreonam disk 27mm
Cefpodoxime disk 22mm

24. ESBL-producing E. coli & Klebsiella
Criteria Susceptible ESBL test
Cefotaxime   27 mm
Ceftazidime   22
Aztreonam   27
Cefpodoxime   22
Ceftriaxone   25
NCCLS M2-A7, 2000

25. Double disk synergy test; ESBL
Cefotaxime
Amoxicillin/Clavulanic acid
Ceftazidime
Aztreonam

26. Salmonella spp.

27. Shigella sonnei

28. Effective -lactams for ESBL
Carbapenems
Imipenem, meropenem
Cephamycins
Cefotetan, cefoxitin, cefmetazole
Anti-Pseudomonas (4세대) cephalosporins
Cefepime, cefpirome
-lactamase inhibitor
Piperacillin/tazobactam