Abstract
Background
Multidrug-resistant tuberculosis (MDR-TB) and extensively drug resistant tuberculosis (XDR-TB) are serious threats to worldwide tuberculosis control, but the national burden and the trends of infectious spread are largely unknown.
Methods
We retrospectively reviewed the results of drug sensitivity tests and medical records of patients that were diagnosed with culture-confirmed pulmonary tuberculosis and were admitted to the National Masan Tuberculosis Hospital between 2001 and 2005.
Results
From 2001 to 2005, the proportion of MDR-TB among new cases was 9.2%, 13.8%, 16.9%, 23% and 27.0% in 2001, 2002, 2003, 2004 and 2005, respectively, and the proportion of MDR-TB among previously treated cases was 58.5%, 60.2%, 62.7%, 61.7% and 71.3% in 2001, 2002, 2003, 2004 and 2005, respectively. A significant increasing trend could be discerned for MDR-TB among both new and previously treated cases (p<0.001, p=0.002 for trend, respectively). The proportion of XDR-TB among new cases was 0%, 2.3%, 3.1%, 2.5% and 6.3% in 2001, 2002, 2003, 2004 and 2005, respectively, and the proportion of XDR-TB among previously treated cases was 9.1%, 15.7%, 17.3%, 19.9% and 19.1% in 2001, 2002, 2003, 2004 and 2005, respectively. A significant increasing trend could be discerned for XDR-TB among both new and previously treated cases (p=0.005, p<0.001 for trend, respectively).
Figures and Tables
Table 1
Characteristics of the study subjects hospitalized in National Masan Tuberculosis Hospital (NMTH)
![trd-64-187-i001](/upload/SynapseData/ArticleImage/0003trd/trd-64-187-i001.jpg)
References
1. Centers for Disease Control and Prevention. Emergence of Mycobacterium tuberculosis with extensive resistance to second-line drugs--worldwide, 2000~2004. MMWR Morb Mortal Wkly Rep. 2006. 55:301–305.
2. Bai GH, Park YK, Choi YW, Bai JI, Kim HJ, Chang CL, et al. Trend of anti-tuberculosis drug resistance in Korea, 1994~2004. Int J Tuberc Lung Dis. 2007. 11:571–576.
3. Kim BJ, Lee IH, Lee DH, Bai GH, Kong SJ, Lee SH, et al. The current status of multidrug-resistant tuberculosis in Korea. Tuberc Respir Dis. 2006. 60:404–411.
4. Centers for Disease Control and Prevention. Revised definition of extensively drug-resistant tuberculosis. MMWR. 2006. 55:1176.
5. Mukherjee JS, Rich ML, Socci AR, Joseph JK, Viru FA, Shin SS, et al. Programmes and principles in treatment of multidrug-resistant tuberculosis. Lancet. 2004. 363:474–481.
6. Torun T, Gungor G, Ozmen I, Bolukbasi Y, Maden E, Bicakci B, et al. Side effects associated with the treatment of multidrug-resistant tuberculosis. Int J Tuberc Lung Dis. 2005. 9:1373–1377.
7. Kang YA, Choi YJ, Cho YJ, Lee SM, Yoo CG, Kim YW, et al. Cost of treatment for multidrug-resistant tuberculosis in South Korea. Respirology. 2006. 11:793–798.
8. Zignol M, Hosseini MS, Wright A, Weezenbeek CL, Nunn P, Watt CJ, et al. Global incidence of multidrug-resistant tuberculosis. J Infect Dis. 2006. 194:479–485.
9. Aziz MA, Wright A, Laszlo A, De Muynck A, Portaels F, Van Deun A, et al. Epidemiology of antituberculosis drug resistance (the Global Project on Anti-tuberculosis Drug Resistance Surveillance): an updated analysis. Lancet. 2006. 368:2142–2154.
10. World Health Organization. Global map and information on XDR-TB [internet]. 2007. cited 2007 Dec 31. Geneva: WHO;Available from:
http://www.who.int/tb/challenges/xdr/xdrmap_oct07_en.pdf.
11. World Health Organization. Document no. WHO/HTM/TB/2006.361. Guidelines for the programmatic management of drug-resistant tuberculosis. 2006. Geneva: WHO.
12. Kim SJ, Bai GH, Hong YP. Drug-resistant tuberculosis in Korea, 1994. Int J Tuberc Lung Dis. 1997. 1:302–308.
13. Korean Center for Disease Control and Prevention. Annual report on the notified tuberculosis patients in Korea, 2005.1-2005.12. 2006. Seoul: Korean Center for Disease Control and Prevention.
14. Kim JH, Kim JH, Jang TW, Jung MH. Drug-resistant pulmonary tuberculosis in Kosin Medical Center. Tuberc Respir Dis. 1995. 42:831–837.
15. Kim SY, Jeong SS, Kim KW, Shin KS, Park SG, Kim AK, et al. Drug-resistant pulmonary tuberculosis in a tertiary referral hospital in Korea. Korean J Intern Med. 1999. 14:27–31.
16. Son CH, Yang DK, Rho MS, Jeong JS, Lee H, Lee KN, et al. Prevalence of drug-resistance 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.
17. Lee JH, Chang JH. Drug-resistant tuberculosis in a tertiary referral teaching hospital of Korea. Korean J Intern Med. 2001. 16:173–179.
18. Kim DK, Kim MO, Kim TH, Sohn JW, Yoon HJ, Shin DH, et al. The prevalence and risk factors of drug resistance pulmonary tuberculosis investigated at one university hospital in Seoul. Tuberc Respir Dis. 2005. 58:243–247.
19. Choi JC, Lim SY, Suh GY, Chung MP, Kim H, Kwon OJ, et al. Drug resistance rates of Mycobacterium tuberculosis at a private referral center in Korea. J Korean Med Sci. 2007. 22:677–681.
20. Raviglione MC, Smith IM. XDR tuberculosis--implications for global public health. N Engl J Med. 2007. 356:656–659.
21. Gandhi NR, Moll A, Sturm AW, Pawinski R, Govender T, Lalloo U, et al. Extensively drug-resistant tuberculosis as a cause of death in patients co-infected with tuberculosis and HIV in a rural area of South Africa. Lancet. 2006. 368:1575–1580.
22. A controlled study of rifabutin and an uncontrolled study of ofloxacin in the retreatment of patients with pulmonary tuberculosis resistant to isoniazid, streptomycin and rifampicin. Hong Kong Chest Service/British Medical Research Council. Tuberc Lung Dis. 1992. 73:59–67.
23. Tahaoglu K, Torun T, Sevim T, Atac G, Kir A, Karasulu L, et al. The treatment of multidrug-resistant tuberculosis in Turkey. N Engl J Med. 2001. 345:170–174.
24. Ginsburg AS, Hooper N, Parrish N, Dooley KE, Dorman SE, Booth J, et al. Fluoroquinolone resistance in patients with newly diagnosed tuberculosis. Clin Infect Dis. 2003. 37:1448–1452.
25. Park IN, Hong SB, Oh YM, Lim CM, Lee SD, Lew WJ, et al. Impact of short-term exposure to fluoroquinolones on ofloxacin resistance in HIV-negative patients with tuberculosis. Int J Tuberc Lung Dis. 2007. 11:319–324.
26. Chang CH, Lee EY, Park SK, Jeong SH, Park YK, Choi TW, et al. A trend in acquired drug resistances of tuberculosis patients registered in health centers from 1981 to 2004. Tuberc Respir Dis. 2005. 59:619–624.