A Nationwide Multicenter Survey for Mycobacterial Testing in Korea

Sae Am Song; Si Hyun Kim; Chang-Ki Kim; Heungsup Sung; Sunjoo Kim; Chulhun L Chang; Jeong Hwan Shin

doi:10.5145/ACM.2015.18.3.69

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Song, Kim, Kim, Sung, Kim, Chang, and Shin: A Nationwide Multicenter Survey for Mycobacterial Testing in Korea

Original Article

Ann Clin Microbiol 2015;18(3):69-75.

Published online: 5 September 2015

DOI: https://doi.org/10.5145/ACM.2015.18.3.69

A Nationwide Multicenter Survey for Mycobacterial Testing in Korea

Sae Am Song¹, Si Hyun Kim^1,⁶, Chang-Ki Kim², Heungsup Sung³, Sunjoo Kim⁴, Chulhun L Chang⁵, Jeong Hwan Shin^1,⁶

¹Department of Laboratory Medicine, Inje University College of Medicine, Busan, Korea

²Department of Laboratory Medicine, Korean Institute of Tuberculosis, Osong, Korea

³Department of Laboratory Medicine, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea

⁴Department of Laboratory Medicine, Gyeongsang National University School of Medicine, Jinju, Korea

⁵Department of Laboratory Medicine, Pusan National University School of Medicine, Yangsan, Korea

⁶Paik Institute for Clinical Research, Inje University College of Medicine, Busan, Korea

Correspondence: Jeong Hwan Shin, Department of Laboratory Medicine, Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, Busan 47392, Korea. (Tel) 82-51-890-6475, (Fax) 82-51-893-1562, (E-mail) jhsmile@inje.ac.kr

Received 21 April 201520 July 2015 Accepted 29 July 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

초록

Background

There have been steady changes and improvements in diagnostic tests for Mycobacterium tuberculosis, so it is necessary to carry out periodic surveys to understand the current situation. The aims of this study were to investigate the changes in prin-cipal practices and quality control for M. tuberculosis using a nationwide survey in the Republic of Korea.

Methods

We constructed a questionnaire composed of four subseries with 42 items. We e-mailed this survey to members of the Korean Society of Clinical Microbiology from April to September 2014 and ana-lyzed the replies.

Results

Employees at a total of 65 hospital laboratories and 5 commercial laboratories participated in the survey. AFB staining was reportedly performed in all 70 institutions, and fluorescent staining was used as the primary detection method in 59 (84.3%) laboratories. Solid and liquid culture methods for Mycobacterium were performed at 62 (88.6%) and 59 (84.3%) laboratories, respectively. There were 57 laboratories (90.5%) that identified strains growing on primary culture media using a rapid antigen kit or molecular method. The mean values of positive and contamination rates for solid culture media were 8.2% (range 3.7-19.9%) and 4.0% (0.4-8.4%), respectively. In liquid culture, the mean values of positive and contamination rates were 11.5% (4.8-22.3%) and 6.8% (0.3-18.7%), respectively.

Conclusion

There have been significant changes and improvements in overall mycobacterial testing, espe-cially in the numbers of laboratories using fluorescent staining, liquid culture, and identification of M. tuberculosis cultured media compared with previous surveys in Korea.

Keywords: Korea, Survey, Tuberculosis

REFERENCES

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Table 1.

General characteristics of mycobacterial testing in Korea

Scale of laboratories	No. (%) of laboratories
Scale of laboratories	AFB stain	Solid culture	Liquid culture	AST (conventional)	) AST (molecular)	ID (colony)	ID (specimen)	ID (NTM)	IGRA
＜500 beds (n=15)	15 (100)	10 (66.7)	9 (60.0)		1 (6.7)	9 (60.0)	9 (60.0)	1 (6.7)	2 (13.3)
500-999 beds (n=36)	36 (100)	33 (91.7)	31 (86.1)		17 (47.2)	30 (83.3)	34 (94.4)	12 (33.3)	10 (27.8)
≥1,000 beds (n=14)	14 (100)	14 (100)	14 (100)	2 (14.2)	10 (71.4)	14 (100)	13 (92.9)	8 (57.1)	12 (85.7)
Commercial laboratories (n=5)	5 (100)	5 (100)	5 (100)	5 (100)	5 (100)	5 (100)	5 (100)	5 (100)	5 (100)
Total (n=70)	70 (100)	62 (88.6)	59 (84.3)	7 (10.0)	33 (47.1)	57 (81.4)	61 (87.1)	26 (37.1)	29 (41.4)

Abbbrevations: AFB, acid fast bacilli; AST, antimycobacterial susceptibility test; ID, identification; IGRA, interferon-γ releasing assay.

Table 2.

Principle method for staining, culture, and susceptibility of mycobacterial testing

Method	No. (%) of laboratories
Primary AFB stain
Ziehl-Neelsen	11 (15.7)
Fluorochrome	59 (84.3)
Total	70 (100)
Primary culture medium
Ogawa 3% and MGIT	36 (57.1)
Ogawa 2% and MGIT	11 (17.5)
Ogawa 3% and BactAlert	4 (6.3)
Ogawa 2% and BactAlert	1 (1.6)
Ogawa 3% only	4 (6.3)
Others	5 (7.9)
No answer	2 (3.2)
Total	63 (100)
Susceptibility test
Conventional methods	7 (17.5)
Molecular methods	33 (82.5)
Total	40 (100)

Table 3.

Principle method for primary identification of mycobacterial isolates

Scale of hospitals with	No. (%) of laboratories						Total
Scale of hospitals with	No ID	Immunochromatography (Rapid)	PCR (conventional)	PCR (real-time)	Others	No answer	Total
＜500 beds (n=15)	2 (2.9)	5 (7.1)		1 (1.4)		7 (10.0)	15 (21.4)
500-999 beds (n=36)	3 (4.3)	17 (24.3)	6 (8.6)	6 (8.6)	2 (2.9)	2 (2.9)	36 (51.4)
1,000≤ beds (n=14)		6 (8.6)	5 (7.1)	2 (2.9)	1 (1.4)		14 (20.0)
Commercial laboratories (n	=5)	3 (4.3)	1 (1.4)	1 (1.4)			5 (7.1)
Total (n=70)	5 (7.1)	31 (44.3)	12 (17.1)	10 (14.3)	3 (4.3)	9 (12.9)	70 (100)

Abbbrevation: ID, identification.

Table 4.

Current status of participants for quality control

Test	No. (%) of laboratories
Test	Internal QC	External QC
AFB stain	70/70 (100)	70/70 (100)
AFB culture	59/63 (93.7)	56/63 (88.9)

Abbbrevation: AFB, acid fast bacilli.

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