Journal List > Tuberc Respir Dis > v.69(2) > 1001578

TOOLS
Park, Koh, Kim, Kim, Kim, Kim, Kim, Kim, Park, Park, Park, Lee, Song, Lee, Lee, Lee, Yim, Lim, Jegal, Jung, Huh, Choi, and Shim: Treatment Outcomes and Prognostic Factors in Patients with Multidrug-Resistant Tuberculosis in Korean Private Hospitals
Original Article
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2010; 69(2): 95-102.

Published online: 31 August 2010

DOI: https://doi.org/10.4046/trd.2010.69.2.95

Treatment Outcomes and Prognostic Factors in Patients with Multidrug-Resistant Tuberculosis in Korean Private Hospitals

Jin Kyeong Park, M.D.1, Won-Jung Koh, M.D.2, Deog Kyeom Kim, M.D.2, Eun Kyung Kim, M.D.2, Yu Il Kim, M.D.2, Hee Jin Kim, M.D.2, Tae-Hyung Kim, M.D.2, Jae Yeol Kim, M.D.2, Moo Suk Park, M.D.2, I-Nae Park, M.D.2, Jae Seuk Park, M.D.2, Ki Man Lee, M.D.2, Sook Hee Song, M.D.2, Jin Hwa Lee, M.D.2, 3, Seung Heon Lee, M.D.2, Hyuk Pyo Lee, M.D.2, Jae-Joon Yim, M.D.2, Jaemin Lim, M.D.2, Yang Jin Jegal, M.D.2, Ki Hwan Jung, M.D.2, Jin Won Huh, M.D.2, Jae Chol Choi, M.D.2, Tae Sun Shim, M.D.1, 2

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

2Korean TB Study Group, Korean Academy of Tuberculosis and Respiratory Diseases, Seoul, Korea.

3Department of Pulmonary and Critical Care Medicine, Ewha Womans University School of Medicine, Seoul, Korea.

Address for correspondence: Tae Sun Shim, M.D. Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 86, Asanbyeongwon-gil, Songpa-gu, Seoul 138-736, Korea. Phone: 82-2-3010-3892, Fax: 82-2-3010-6968, shimts@amc.seoul.kr

Received 8 June 2010       Accepted 29 June 2010

Copyright © 2010. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved.

Abstract

Background

The increasing rate of drug-resistant tuberculosis (TB) is a threat to the public health and TB control. In Korea, about 75~80% of TB patients are treated in private hospitals and the rate has been continuously increasing since 2000.

Methods

On a retrospective basis, we enrolled 170 newly diagnosed with or retreated for multidrug-resistant TB (MDR-TB) in 2004 from 21 private hospitals. We extracted the following demographics and treatment history from patient medical records: initial treatment outcomes, cumulative survival rates, treatment outcomes, and prognostic factors.

Results

Of the 170 patients, the majority were male (64.1%), the mean age was 44.5 years old, and mean body-mass-index was 20.2 kg/m2. None of the patients tested positive for HIV. Eleven (6.5%) were confirmed to have extensively drug-resistant TB (XDR-TB) at treatment initiation. Treatment success rates were not different between XDR-TB (36.4%, 4/11) and non-XDR MDR-TB (51.6%, 82/159). Default rate was high, 21.8% (37/170). Far advanced disease on X-ray was a significant negative predictor of treatment success; advanced disease and low BMI were risk factors for all-cause mortality.

Conclusion

In private hospitals in Korea, the proportion of XDR-TB in MDR-TB was comparable to previous data. The treatment success rate of MDR-/XDR-TB remains poor and the failure rate was quite high. Adequate TB control policies should be strengthened to prevent the further development and spread of MDR-/XDR-TB in Korea.

Keywords: Tuberculosis, Multidrug-Resistant, Extensively Drug-Resistant Tuberculosis, Korea, Hospitals, Private

Figures and Tables

Figure 1
Survival curve in XDR-TB and Non-XDR MDR-TB. There was no survival difference between XDR-TB and Non-XDR MDR-TB groups (p=0.1). XDR: extensively drug-resistant; TB: tuberculosis; MDR: multidrug-resistant.
trd-69-95-g001
Table 1
Baseline clinical characteristics of 170 patients with MDR-TB
trd-69-95-i001

Values are presented as number (%) or mean±SD and (range).

AFB: acid-fast bacilli; BMI: body mass index; MDR: multidrug-resistant; TB: tuberculosis; XDR: extensively drug-resistant.

*p<0.05 between XDR-TB and non-XDR MDR-TB group.

Table 2
Drug resistance rate at treatement initiation
trd-69-95-i002

Values are presented ad number (%).

MDR: multidrug-resistant; TB: tuberculosis; XDR: extensively drug-resistant.

*p<0.05 between XDR-TB and non-XDR MDR-TB group.

Table 3
Treatment modalities
trd-69-95-i003

Values are presented as median (range) or number (%).

MDR: multidrug-resistant; TB: tuberculosis; XDR: extensively drug-resistant.

*p<0.05 between XDR-TB and Non-XDR MDR-TB, †Drugs with unknown activity include drugs with unclear TB efficacy (clofazimine and amoxicillin/clavulanate) and TB drugs with unknown DST results (amikacin, moxifloxacin, and rifabutin), ‡Potentially effective drugs include either "previously unused and sensitive drugs" or "previously unused and activity-unknown drugs."

Table 4
Baseline characteristics and treatment outcomes according to previous treatment history
trd-69-95-i004

Tx: treatment; BMI: body mass index; MDR: multidrug-resistant; TB: tuberculosis; XDR: extensively drug-resistant; Treatment success: cure+treatment completion+short-term treatment completion.

Values are number (%) or mean±SD.

*p<0.05 between groups according to previous treatment history.

Table 5
Treatment outcomes
trd-69-95-i005

Values are presented as number (%).

p>0.05 between XDR-TB and Non-XDR MDR-TB.

MDR: multidrug-resistant; TB: tuberculosis; XDR: extensively drug-resistant; Treatment success: cure+treatment completion +short-term treatment completion.

Table 6
Predictors of treatment success
trd-69-95-i006

Values are presented as number (%) or mean±SD.

BMI: body mass index; CI: confidence interval; OR: odds ratio; TB: tuberculosis; XDR: extensively drug-resistant; Treatment success: cure+treatment completion+short-term treatment completion.

*OR was for treatment success, †p<0.05 between treatment success and others.

Table 7
Predictors of all-cause mortality
trd-69-95-i007

Values are presented as number (%) or mean±SD.

AFB: acid-fast bacilli; BMI: body mass index; CI: confidence interval; HR: hazard ratio; TB: tuberculosis; XDR: extensively drug-resistant.

*HR for all-cause mortality.

References

1. 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.
2. World Health Organization. Guidelines for the programmatic management of drug-resistant tuberculosis. 2008. Geneva: World Health Organization.
3. Caminero JA. World Health Organization. American Thoracic Society. British Thoracic Society. Treatment of multidrug-resistant tuberculosis: evidence and controversies. Int J Tuberc Lung Dis. 2006. 10:829–837.
4. Korea Center for Disease Control and Prevention, Korean Institute of Tuberculosis. Annual report on the notified tuberculosis patients in Korea. 2005. Seoul: Korea Center for Disease Control and Prevention.
5. Koh WJ, Kwon OJ, Kim CH, Ahn YM, Lim SY, Yun JW, et al. Clinical characteristics and treatment outcomes of patients with pulmonary tuberculosis at a private general hospital. Tuberc Respir Dis. 2003. 55:154–164.
6. 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.
7. World Health Organization. Extensively drug-resistant tuberculosis (XDR-TB): recommendations for prevention and control. Wkly Epidemiol Rec. 2006. 81:430–432.
8. Laserson KF, Thorpe LE, Leimane V, Weyer K, Mitnick CD, Riekstina V, et al. Speaking the same language: treatment outcome definitions for multidrug-resistant tuberculosis. Int J Tuberc Lung Dis. 2005. 9:640–645.
9. Migliori GB, Sotgiu G, D'Arcy Richardson M, Centis R, Facchini A, Guenther G, et al. MDR-TB and XDR-TB: drug resistance and treatment outcomes. Eur Respir J. 2009. 34:778–779.
10. Park SK, Lee CM, Heu JP, Song SD. A retrospective study for the outcome of pulmonary resection in 49 patients with multidrug-resistant tuberculosis. Int J Tuberc Lung Dis. 2002. 6:143–149.
11. Shiraishi Y, Nakajima Y, Katsuragi N, Kurai M, Takahashi N. Resectional surgery combined with chemotherapy remains the treatment of choice for multidrug-resistant tuberculosis. J Thorac Cardiovasc Surg. 2004. 128:523–528.
12. Kim HR, Hwang SS, Kim HJ, Lee SM, Yoo CG, Kim YW, et al. Impact of extensive drug resistance on treatment outcomes in non-HIV-infected patients with multidrug-resistant tuberculosis. Clin Infect Dis. 2007. 45:1290–1295.
13. Kwon YS, Kim YH, Suh GY, Chung MP, Kim H, Kwon OJ, et al. Treatment outcomes for HIV-uninfected patients with multidrug-resistant and extensively drug-resistant tuberculosis. Clin Infect Dis. 2008. 47:496–502.
14. Rivers EC, Mancera RL. New anti-tuberculosis drugs with novel mechanisms of action. Curr Med Chem. 2008. 15:1956–1967.
15. Diacon AH, Pym A, Grobusch M, Patientia R, Rustomjee R, Page-Shipp L, et al. The diarylquinoline TMC 207 for multidrug-resistant tuberculosis. N Engl J Med. 2009. 360:2397–2405.
16. Koh WJ, Kwon OJ, Gwak H, Chung JW, Cho SN, Kim WS, et al. Daily 300 mg dose of linezolid for the treatment of intractable multidrug-resistant and extensively drug-resistant tuberculosis. J Antimicrob Chemother. 2009. 64:388–391.
17. Park IN, Hong SB, Oh YM, Kim MN, Lim CM, Lee SD, et al. Efficacy and tolerability of daily-half dose linezolid in patients with intractable multidrug-resistant tuberculosis. J Antimicrob Chemother. 2006. 58:701–704.
TOOLS
ORCID iDs

Jin Hwa Lee
https://orcid.org/http://orcid.org/0000-0003-0843-9862

Similar articles