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Kim, Lee, Lee, Bai, Kong, Lee, Moon, Lee, Lee, and Park: The Current Status of Multidrug-resistant Tuberculosis in Korea
Original Article
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2006; 60(4): 404-411.

Published online: 30 April 2006

DOI: https://doi.org/10.4046/trd.2006.60.4.404

The Current Status of Multidrug-resistant Tuberculosis in Korea

Byoung-Ju Kim, In-Hee Lee, Duk-Hyung Lee, Gill-Han Bai1, Suk-Jun Kong2, Sun-Hwa Lee3, Hae-Ran Moon4, Kyoung-Ryul Lee5, Jun-Young Lee6, Seung-Kyu Park

National Masan Tuberculosis Hospital, Masan, Korea.

1Korean Institute of Tuberculosis, Seoul, Korea.

2National Mokpo Tuberculosis Hospital, Mokpo, Korea.

3NeoDIN Medical Institute, Seoul, Korea.

4Green Cross Reference Laboratory, Seoul, Korea.

5Seoul Clinical Laboratories, Seoul, Korea.

6Seobuk Hospital, Seoul, Korea.

Address for correspondence: Seung-Kyu Park, M.D., Ph.D. Clinical Research Center for Tuberculosis, National Masan Hospital, 486, Kapo-dong, Masan, Gyeongnam 631-710, Korea. Phone: +8255-249-3729, Fax: +8255-241-0992, pulmo116@empal.com

Received 23 January 2006       Accepted 23 March 2006

Copyright © 2006 The Korean Academy of Tuberculosis and Respiratory Diseases

Abstract

Purpose

Multidrug-resistant tuberculosis (MDR-TB) is an emerging threat to human beings. However, there is little data on the current status of MDR-TB in Korea. This study investigated the current status of MDR-TB in Korea using a survey of all the data from drug susceptibility tests (DST) performed across the country over the last three years.

Method

The DST results between Jan. 2000 and Dec. 2002 from 7 laboratories, which were in charge of all antituberculous DSTs across the country as of March 2002, were collected and analyzed to determine the actual number of drug-resistant or MDR-TB patients, annual trend, degree and pattern of resistance against anti-TB drugs, etc.

Results

Six laboratories used the absolute concentration method for DST and one used the proportional method. 59, 940 tests had been performed over the 3 year study period. The number of DST performed annually was 18,071, 19,950, and 21,919 in 2000-2002, respectively. The number of resistant tuberculosis patients (resistant against at least one anti-TB drug) had increased by 16.9% from 6,338 in 2000 to 7,409 in 2002. The rate of resistant tuberculosis among all DST results was 35.1% in 2000, 34.5% in 2001, and 33.8% in 2002. The number of MDR-TB patients (resistant against at least both isoniazid and rifampin) showed an increasing trend (14.5%) from 3,708 in 2000 to 4,245 in 2002.

Conclusion

Approximately 4,000 MDR-TB cases are newly identified by DST annually and the number is showing an increasing trend. This study suggests that in order to cope with the current MDR-TB situation, the DST methods will need to be standardized and more aggressive measures will be required.

Keywords: Multidrug-resistant tuberculosis, Drug susceptibility test

Figures and Tables

Figure 1
The number of DST performed in 7 laboratories.
*Tuberculosis resistant to at least one drug
†Multidrug-resistant tuberculosis
trd-60-404-g001
Table 1
The number of DST performed in 7 laboratories and drug resistant tuberculosis rate
trd-60-404-i001

*Resistant TB(resistant to at least one drug), †MDR-TB(resistant to at least both of INH and RFP)

KIT: Korea Institute of Tuberculosis, SCL: Seoul Clinical Laboratories, GCRL: Green Cross Reference Laboratory, Seobuk: Seobuk Hospital, NeoDIN: NeoDIN Medical Institute, Masan: National Masan Hospital, Mokpo: National Mokpo Hospital

Table 2
Anti-tuberculosis drug resistance rate (%)
trd-60-404-i002

INH: isoniazid, RFP: rifampicin, EMB: ethambutol, PZA: pyrazinamide, PAS: para-aminosalicylic acid, ETH: ethionamide, CS: cycloserine, OFX: ofloxacin, SM: streptomycin, KM: kanamycin

Table 3
The resistant rate according to the number of resistant drugs
trd-60-404-i003
Table 4
The methods and critical concentrations of DST performed in 7 laboratories
trd-60-404-i004

*pyrazinamidase

KIT: Korea Institute of Tuberculosis, SCL: Seoul Clinical Laboratories, GCRL: Green Cross Reference Laboratory, Seobuk: Seobuk Hospital, NeoDIN: NeoDIN Medical Institute, Masan: National Masan Hospital, Mokpo: National Mokpo Hospital

Table 5
The drug resistance rate by methods of DST
trd-60-404-i005

*absolute concentration method, †proportional method

Table 6
PZA resistant rate by methods of DST
trd-60-404-i006

*Total number of testing: 2,099 for pyrazinamidase, 44,315 for absolute concentration

Table 7
The distribution of MDR-TB patients according to their sex (National Masan and Mokpo Hospital)
trd-60-404-i007
Table 8
The distribution of MDR-TB patients according to their age (National Masan and Mokpo Hospital)
trd-60-404-i008
Table 9
The distribution of MDR-TB patients according to their residence (National Masan and Mokpo Hospital)
trd-60-404-i009

References

1. Bai GH. Anti-tuberculosis drug resistance in Korea. CDMR. 2005. 16:101–107.
2. Korea Center for Disease Control and Prevention/Korean Institute of Tuberculosis. Tuberculosis notification report: 2004.1-2004.12. 2005. Seoul: KCDC/KIT.
3. Son CH, Yang DG, No MS, Jeong JS, Lee H, Lee GN, et al. Prevalence of drug-resistances in patients with pulmonary tuberculosis and its association with clinical characteristics at one tertiary referral hospital in Pusan, Korea. Tuberc Respir Dis. 2001. 51:416–425.
4. Kim JH, Kim JH, Jang TW, Jung MH. Drug-resistant pulmonary tuberculosis in Kosin Medical Center. Tuberc Respir Dis. 1995. 42:831–837.
5. The WHO/IUATLD global project on anti-tuberculosis drug resistance surveillance. Anti-tuberculosis drug resistance in the world report: third global report. 2004. Geneva: WHO.
6. Koh WJ, Kwon OJ, Kim CH, Ahn YM, Lim SY, Yun JU, et al. Clinical characteristics and treatment outcomes of patients with pulmonary tuberculosis at a private general hospital. Tuberc Respir Lung Dis. 2003. 55:154–164.
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