The Recent Status of Multidrug- and Extensively Drug-Resistant Tuberculosis in Korea

Sun Young Kim; Hee Jin Kim; Chang Ki Kim; Hye Ryung Yoon; Hye-Gyung Bae; Sun-Hwa Lee; Nackmoon Sung; Dae Yeon Kim; Gang Young Lee; Young Soo Cho; Sang Do Lee; Woo Sung Kim; Dong Soon Kim; Tae Sun Shim

doi:10.4046/trd.2010.68.3.146

Journal List > Tuberc Respir Dis > v.68(3) > 1001480

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Kim, Kim, Kim, Yoon, Bae, Lee, Sung, Kim, Lee, Cho, Lee, Kim, Kim, and Shim: The Recent Status of Multidrug- and Extensively Drug-Resistant Tuberculosis in Korea

Original Article

Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2010; 68(3): 146-154.

Published online: 31 March 2010

DOI: https://doi.org/10.4046/trd.2010.68.3.146

The Recent Status of Multidrug- and Extensively Drug-Resistant Tuberculosis in Korea

Sun Young Kim, M.D.¹, Hee Jin Kim, M.D.², Chang Ki Kim, M.D.², Hye Ryung Yoon, M.D.³, Hye-Gyung Bae, M.D.⁴, Sun-Hwa Lee, M.D.⁵, Nackmoon Sung, Ph.D.⁶, Dae Yeon Kim, M.D.⁷, Gang Young Lee, M.D.⁸, Young Soo Cho, M.D.⁸, Sang Do Lee, M.D.¹, Woo Sung Kim, M.D.¹, Dong Soon Kim, M.D.¹, Tae Sun Shim, M.D.¹

¹Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

²Korean Institute of Tuberculosis, Seoul, Korea.

³Seoul Medical Science Institute, Seoul, Korea.

⁴Green Cross Reference Laboratory, Seoul, Korea.

⁵Neodin Medical Institute, Seoul, Korea.

⁶National Masan Hospital, Masan, Korea.

⁷National Mokpo Hospital, Mokpo, Korea.

⁸Seobuk Hospital, Seoul, Korea.

Address for correspondence: Tae Sun Shim, M.D. Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap 2-dong, Songpa-gu, Seoul 138-736, Korea. Phone: 82-2-3010-3892, Fax: 82-2-3010-6968, shimts@amc.seoul.kr

Received 28 January 2010 Accepted 17 February 2010

Abstract

Background

The increasing incidence of multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) has become a serious worldwide problem. However, there is insufficient data regarding the current status of MDR-TB and XDR-TB in Korea. This study examined the recent status of MDR- and XDR-TB using the data from 7 laboratories, in which almost all drug susceptibility tests (DST) for Mycobacterium tuberculosis were performed.

Methods

The patients' identification data and DST results were collected from all 7 laboratories from 2001 to 2006 and the number of patients with MDR-TB and XDR-TB were calculated.

Results

The number of DSTs was 140,638 for 6 years with an increasing incidence each year (p<0.001). The number of DST with MDR results was 18,510 and personal identifying information was obtained in 16,640 (89.9%) tests. The number of MDR-TB patients from 2001 to 2006 was 2,329, 2,496, 2,374, 2,300, 2,354, and 2,178, respectively, when counting the duplications in a year as one patient. The number of MDR-TB patients when counting the duplications in 6 years as one patient was 2,281, 1,977, 1,620, 1,446, 1,512, and 1,373, respectively. When the same method was adopted, the number of XDR-TB patients was 191, 238, 282, 260, 272, and 264, respectively, and 189, 150, 130, 90, 122, and 110 patients, respectively.

Conclusion

Despite the national efforts to control TB, there are still a large number of MDR- and XDR-TB patients in Korea.

Keywords: Tuberculosis, Multidrug-Resistant, Extensively Drug-Resistant Tuberculosis, Microbial Sensitivity Tests, Korea

Figures and Tables

Figure 1

The number of MDR-TB patients. A method: exclusion of the patients duplicated only in a same year, B method: exclusion of any duplicated patients in whole 6 years and inclusion of the case in the first year, MDR-TB: multidrug-resistant tuberculosis.

Figure 2

The number of XDR-TB patients. A method: exclusion of the patients duplicated only in a same year, B method: exclusion of any duplicated patients in whole 6 years and inclusion of the case in the first year, XDR-TB: extensively drug-resistant tuberculosis.

Table 1

The methods and critical concentrations of DST performed in 7 laboratories (adapted from reference 7)

DST: drug susceptibility test; INH: isoniazid; RFP: rifampicin; EMB: ethambutol; PZA: pyrazinamide; PAS: p-aminosalicylate; PTH: prothionamide; CS: cycloserine; OFX: ofloxacin; KM: kanamycin; SM: streptomycin; KIT: Korea Institute of Tuberculosis; Masan: National Masan Hospital; Mokpo: National Mokpo Hospital; Seobuk: Seobuk Hospital; SCL: Seoul Medical Science Institute; GCRL: Green Cross Reference Laboratory; NeoDIN: Neodin Medical Institute.

^*Pyrazinamidase.

Table 2

The number of DST performed in 7 laboratories

The number of DST is increasing year by year (p<0.001). Statistical analysis was performed using chi-square test for trend.

KIT: Korea Institute of Tuberculosis; Masan: National Masan Hospital; Mokpo: National Mokpo Hospital; Seobuk: Seobuk Hospital; SCL: Seoul Medical Science Institute; GCRL: Green Cross Reference Laboratory; NeoDIN: Neodin Medical Institute.

Table 3

The number of patients in whom DST was performed in 7 laboratories

The number of patients in whom DST was performed is increasing year by year (p<0.001). Statistical analysis was performed using chi-square test for trend.

Table 4

The number of MDR-TB results

Table 5

The number of MDR-TB patients calculated by 'A' method

The number of MDR-TB patients calculated by 'A' method showed decreasing trend (p<0.001). Statistical analysis was performed using chi-square test for trend. A method: exclusion of the patients duplicated only in a same year.

Table 6

The number of MDR-TB patients calculated by 'B' method

The number of MDR-TB patients calculated by 'B' method showed decreasing trend (p<0.001). Statistical analysis was performed using chi-square test for trend. B method: exclusion of any duplicated patients in whole 6 years and inclusion of the case in the first year.

Table 7

The number of XDR-TB patients calculated by 'A' method

The number of XDR-TB patients calculated by 'A' method showed increasing trend (p=0.002). Statistical analysis was performed using chi-square test for trend. A method: exclusion of the patients duplicated only in a same year.

Table 8

The number of XDR-TB patients calculated by 'B' method

The number of XDR-TB patients calculated by 'B' method showed decreasing trend (p<0.001). Statistical analysis was performed using chi-square test for trend. B method: exclusion of any duplicated patients in whole 6 years and inclusion of the case in the first year.

Table 9

The distribution of MDR-TB patients according to age

MDR-TB: multidrug-resistant tuberculosis.

Table 10

The distribution of XDR-TB patients according to age

XDR-TB: extensively drug-resistant tuberculosis.

References

1. Pablos-Méndez A, Raviglione MC, Laszlo A, Binkin N, Rieder HL, Bustreo F, et al. Global surveillance for anti-tuberculosis-drug resistance, 1994-1997: World Health Organization-International Union against Tuberculosis and Lung Disease Working Group on Anti-Tuberculosis Drug Resistance Surveillance. N Engl J Med. 1998. 338:1641–1649.

2. 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.

3. Velayati AA, Masjedi MR, Farnia P, Tabarsi P, Ghanavi J, Ziazarifi AH, et al. Emergence of new forms of totally drug-resistant tuberculosis bacilli: super extensively drug-resistant tuberculosis or totally drug-resistant strains in Iran. Chest. 2009. 136:420–425.

4. 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.

5. Bae GH. National tuberculosis control program in Korea: actions for TB elimination. Commun Dis Mon Rep. 2006. 17:1–10.

6. Jeon D, Shin D, Kang H, Sung N, Kweon K, Shin E, et al. Trend of multidrug and extensively drug resistant tuberculosis in a tuberculosis referral hospital, 2001~2005. Tuberc Respir Dis. 2008. 64:187–193.

7. 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.

8. Case definition for extensively drug-resistant tuberculosis. Wkly Epidemiol Rec. 2006. 81:408.

9. Wright A, Zignol M, Van Deun A, Falzon D, Gerdes SR, Feldman K, et al. Epidemiology of anti-tuberculosis drug resistance 2002-07: an updated analysis of the Global Project on Anti-Tuberculosis Drug Resistance Surveillance. Lancet. 2009. 373:1861–1873.

10. Global map and information on XDR-TB: countries that had reported at least one XDR-TB case by September 2009 [internet]. World Health Organization. 2009. cited 2009 Dec 20. Geneva: World Health Organization;Available from: http://www.who.int/tb/challenges/xdr/xdr_map_sep09.pdf.

11. 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.

12. Kim DH, Kim HJ, Park SK, Kong SJ, Kim YS, Kim TH, et al. Treatment outcomes and long-term survival in patients with extensively drug-resistant tuberculosis. Am J Respir Crit Care Med. 2008. 178:1075–1082.

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