The Prevalence of Initial Drug Resistance among Pulmonary Tuberculosis Patients

Jae Hwan Kong; Sang Seok Lee; Ha Yan Kang; Jae Seuk Park

doi:10.4046/trd.2008.64.2.95

Journal List > Tuberc Respir Dis > v.64(2) > 1001254

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Kong, Lee, Kang, and Park: The Prevalence of Initial Drug Resistance among Pulmonary Tuberculosis Patients

Original Article

Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2008; 64(2): 95-101.

Published online: 29 February 2008

DOI: https://doi.org/10.4046/trd.2008.64.2.95

The Prevalence of Initial Drug Resistance among Pulmonary Tuberculosis Patients

Jae Hwan Kong, M.D., Sang Seok Lee, M.D., Ha Yan Kang, M.D., Jae Seuk Park, M.D.

Department of Internal Medicine, Dankook University Hospital, College of Medicine, Dankook University, Cheonan, Korea.

Address for correspondence: Jae Seuk Park, M.D. Department of Internal Medicine, Dankook University Hospital, 16-5, Anseo-dong, Cheonan 330-715, Korea. Phone: 82-41-550-3055, Fax: 82-41-556-3256, jspark@dankook.ac.kr

Received 24 January 2008 Accepted 1 February 2008

Abstract

Background

Drug resistant tuberculosis (TB) in patients who have not received previous TB treatment (initial drug resistance) is a serious problem for the control of TB. However, prevalence of initial drug resistance among pulmonary TB patients has not been well characterized in Korea, especially in the private sector. We assessed the prevalence of initial drug resistance and evaluated the risk factors for drug resistance in pulmonary TB patients, at a regional tertiary hospital in Cheonan.

Methods

We performed a drug susceptibility test for both first and second line anti-TB drugs in all culture-confirmed pulmonary TB patients who had not received a previous TB treatment at Dankook University Hospital from September 2005 to September 2007. In addition, we evaluated the initial drug resistance pattern and clinical characteristics of patients to evaluate the risk factors for initial drug resistance. We also assessed the influence of the drug susceptibility test results on the treatment regimen.

Results

Of the total 156 cases where the drug susceptibility test was performed, resistance to at least one anti-TB drug was found in 21 cases (15.6%) and multidrug resistance, where TB was resistant to at least isoniazid and rifampin, was found in one case (0.6%). Multivariate logistic regression showed no clinical characteristics were independently associated with initial drug resistance. Of the total 156 patients who underwent the drug susceptibility test, the treatment regimen was changed for 15 patients (9.6%) according to the results of the drug susceptibility test.

Conclusion

Initial drug resistance is common and the drug susceptibility test is informative for pulmonary TB patients who have not received previous TB treatment.

Keywords: Drug resistance, Initial, Pulmonary tuberculosis

Figures and Tables

Table 1

Drug resistance pattern of pulmonary tuberculosis patients with initial drug resistance

INH: isoniazid; SM: streptomycin; OFX: ofloxacin; ETH: ethionamide; EMB: ethambutol; PAS: para-aminosalicylic acid; RFP: rifampin.

Table 2

Characteristics of pulmonary tuberculosis patients without previous treatment (n=156)

Data are mean±SD or number of patients (%).

^*sensitive to all first and second line TB drugs. ^†resistant to any first and second line TB drugs. ^‡Fisher's exact test was used for analysis.

Table 3

Risk factors of initial drug resistant in pulmonary tuberculosis

OR: odds ratio; CI: confidence interval.

Univariate and multivariate binary logistic regression analysis.

References

1. Hong Kong Tuberculosis Treatment Services/British Medical Research Council Investigation. British Medical Research Council Investigation. A study in Hong Kong to evaluate the role of pretreatment susceptibility tests in the selection of regiments of chemotherapy for pulmonary tuberculosis. Am Rev Respir Dis. 1972. 106:1–22.

2. Korean Academy of Tuberculosis and Respiratory Diseases. Guideline for the management of pulmonary tuberculosis, 1997. Tuberc Respir Dis. 1997. 44:1447–1453.

3. American Thoracic Society/Center for Disease Control and Prevention. Center for Disease Control and Prevention. Diagnostic standards and classification of tuberculosis in adults and children. Am J Respir Crit Care Med. 2000. 161:1376–1395.

4. Korean Academy of Tuberculosis and Respiratory Diseases. Guideline for the management of pulmonary tuberculosis. 2005. Seoul: Korean Academy of Tuberculosis and Respiratory Diseases.

5. Bai GH. Anti-tuberculosis drug resistance in Korea. CDMR. 2005. 16:101–107.

6. Jung YJ, Park IN, Hong SB, Oh YM, Lim CM, Lee SD, et al. The clinical characteristics, diagnosis, treatment, and outcomes of patients with tuberculosis at a private university hospital in Korea. Tuberc Respir Dis. 2006. 60:194–204.

7. Son CH, Yang DK, Rho MS, Jeong JS, Lee H, Lee KN, 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.

8. Jeong SH, Lee DD, Choi JC, Kim SJ, Shin JH, Jeong JS, et al. Multi-center study on cost effectiveness of anti-tuberculosis drug susceptibility test. Infect Chemother. 2005. 37:16–21.

9. 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.

10. National Tuberculosis Association of USA. Diagnostic standards and classification of tuberculosis. 1961. New York: National Tuberculosis Association.

11. Pablos-Mendez A, Raviglione MC, Laszlo A, Binkin N, Rieder HL, Bustreo F, et al. Global surveillance for antituberculosis-drug resistance, 1994-1997. N Engl J Med. 1998. 338:1641–1649.

12. Dye C, Espinal MA, Watt CJ, Mbiaga C, Williams BG. Worldwide incidence of multidrug-resistant tuberculosis. J Infect Dis. 2002. 185:1197–1202.

13. Koh HK, Kang YJ, Lim SY, Shin JW, Choi JS, Yoo JH, et al. Predictors of drug-resistance in patients with pulmonary tuberculosis. Tuberc Respir Dis. 1999. 46:311–316.

14. Min J, Park K, Whang S, Kim J. Risk factors for primary multidrug resistant tuberculosis. Tuber Respir Dis. 2005. 59:600–605.

15. Koziel H, Koziel MJ. Pulmonary complications of diabetes mellitus. Infect Dis Clin North Am. 1995. 9:65–96.

16. Bashar M, Alcabes P, Rom WN, Condos R. Increased incidence of multidrug-resistant tuberculosis in diabetic patients on the Bellevue Chest Service, 1987 to 1997. Chest. 2001. 120:1514–1519.

17. Kim DK, Kim MO, Kim TH, Sohn JW, Yoon HJ, Shin DH, et al. The prevalence and risk factors of drug resistant pulmonary tuberculosis investigated at one university hospital in Seoul. Tuberc Respir Dis. 2005. 58:243–247.

18. Bass JB Jr, Farer LS, Hopewell PC, O'Brien R, Jacobs RF, Ruben F, et al. Treatment of tuberculosis and tuberculosis infection in adults and children. American Thoracic Society and The Centers for Disease Control and Prevention. Am J Respir Crit Care Med. 1994. 149:1359–1374.

19. American Thoracic Society, Centers for Disease Control and Prevention and the Infectious Diseases Society. American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis. Am J Respir Crit Care Med. 2003. 167:603–662.

20. Escalante P, Graviss EA, Griffith DE, Musser JM, Awe RJ. Treatment of isoniazid-resistant tuberculosis in southeastern Texas. Chest. 2001. 119:1730–1736.

21. Koh WJ, Kwon OJ, Yu CM, Jeon K, Kim KC, Lee BH, et al. Treatment of isoniazid-resistant pulmonary tuberculosis. Tuberc Respir Dis. 2004. 56:248–260.

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