Imipenem 내성을 보인 Acinetobacter baumannii의 항균제 감수성검사의 신빙도 조사

Background : In our hospital, an abrupt increase in the resistant rate of A. baumannii to imipenem was observed. We evaluated the imipenem minimal inhibitory concentration (MIC) of an automated system that our laboratory is using, by comparing with those of other methods. Methods : During the period from February 2002 to February 2003, the imipenem MICs of the agar dilution method, Etest, and the disk diffusion method, were compared for imipenem-resistant A. baumannii tested by an automated system in 46 samples at Chung-Ang University Phil-Dong Hospital. We tested for susceptibility to imipenem with the Vitek system by using the GNI card, the disk diffusion method by using the imipenem disk (BBL), and the agar dilution method. PCR testing of the isolates for carbapenemase genes (IMP-1 and VIM-2) detected in other hospitals was done using published primers and conditions. Results : By the agar dilution method, 23 (50.0%) isolates were susceptible to imipenem, 14 (30.4%) isolates were intermediate, and 9 (19.6%) isolates were resistant. However, by the Etest, 8 (17.4%) were susceptible to imipenem, and 28 (60.9%) isolates were resistant. By the disk diffusion method, the susceptible isolates were 14 (30.4%) and the resistant isolates were 17 (37.0%). Quantitative agreement between the agar dilution method and the disk diffusion test gave an inverse linear correlation coefficient (r=-0.564). The results of the 13 isolates, whose results of the MIC were below 2 or above 16 in the agar dilution method, corresponded with the Etest and the disk diffusion test. The IMP-1 gene was detected in one isolate. Conclusions : It is recommended that when a gram-negative bacilli isolate including A. baumannii is characterized as resistant to imipenem by the Vitek system, an additional simple test, such as the disk diffusion assay, might be used.