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Kim, Park, Lee, Chang, Lee, and Shin: Anti-Tuberculosis Drug Resistant Rates in Mycobacterium tuberculosis Isolated from Respiratory Specimens: A Multicenter Study in Korea
Original Article

Ann Clin Microbiol 2013;16(1):1-7.

Published online: 5 March 2013

DOI: https://doi.org/10.5145/ACM.2013.16.1.1

Anti-Tuberculosis Drug Resistant Rates in Mycobacterium tuberculosis Isolated from Respiratory Specimens: A Multicenter Study in Korea

Jayoung Kim1, Yeon-Joon Park1, Nam Yong Lee2, Chulhun L. Chang3, Miae Lee4, Jong Hee Shin5

1Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea

2Department of Laboratory Medicine, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea

3Department of Laboratory Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea

4Department of Laboratory Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea

5Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, Korea

Correspondence: Yeon-Joon Park, Department of Laboratory Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, 505, Banpo-dong, Seocho-gu, Seoul 137-701, Korea. (Tel) 82-2-2258- 1640, (Fax) 82-2-2258-1719, (E-mail) yjpk@catholic.ac.kr

Received 31 May 201217 September 2012       Accepted 17 September 2012

Copyright © 2013 The Korean Society of Clinical Microbiology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

초록

Background

We analyzed the prevalence of antituberculosis drug resistance in Mycobacterium tuberculosis isolates from respiratory specimens of patients with newly diagnosed and previously treated tuberculosis.

Methods

From February 2010 to July 2010, a total of 542 M. tuberculosis clinical isolates were collected from pulmonary tuberculosis patients in six university hospitals distributed throughout Korea. We analyzed the results of antituberculosis drug resistance tests according to treatment history and geographic location.

Results

Among the 542 isolates, 473 (87.3%) were from newly diagnosed cases and 69 (12.7%) were from previously treated cases. The rates of multi-drug resistance (MDR), fluoroquinolone (ofloxacin, levoflo-xacin, and moxifloxacin) resistance, and extensive drug resistance (XDR) were 3.8%, 1.1-1.5%, and 0%, respectively, in new cases, and 21.7%, 13.0-17.4%, and 4.3%, respectively, in previously treated cases. In the previously treated cases, the proportions of XDR-TB in MDR-TB were 20% (3/15). The resistance rates were variable according to geographic location.

Conclusion

As the antituberculosis drug resistance rates are much higher in newly diagnosed cases than in previously treated patients, efforts should be made to ensure that tuberculosis treatment is successful. In addition, before the selection of an antituberculosis drug treatment for previously treated patients, the susceptibility test results, including to fluoroquinolone, should be verified.

Keywords: Anti-tuberculosis drug resistant rates, Extensive drug resistance, Multidrug resistance, Mycobacterium tuberculosis

REFERENCES

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Fig. 1.
Age distribution among newly and previously treated patients in this study. Abbreviations: New, newly treated patient; Treated, previously treated patient.
acm-16-1f1.tif
Table 1.
Prevalence of antituberculosis drug resistance in this study
No (%) Total no (% of patients) P value
New (%) Treated (%)
Total tested 542 473 69  
≥ One∗ 98 (18.1) 69 (14.6) 29 (42.0) ＜0.001
  Resistance to        
  RFP 39 (7.2) 21 (4.4) 18 (26.1) ＜0.001
  INH 74 (13.7) 49 (10.4) 25 (36.2) ＜0.001
  EMB 25 (4.6) 13 (2.7) 12 (17.4) ＜0.001
  PZA 21 (3.9) 11 (2.3) 10 (14.5) ＜0.001
  RBT 29 (5.4) 16 (3.4) 13 (18.8) 0.002
  SM 36 (6.6) 26 (5.5) 10 (14.5) ＜0.001
  AMK 5 (0.9) 1 (0.2) 4 (5.8) ＜0.001
  KM 5 (0.9) 1 (0.2) 4 (5.8) 0.002
  CPM 4 (0.7) 1 (0.2) 3 (4.3) 0.006
  OFX 19 (3.5) 7 (1.5) 12 (17.4) ＜0.001
  LEV 19 (3.5) 7 (1.5) 12 (17.4) ＜0.001
  MXF 14 (2.6) 5 (1.1) 9 (13.0) ＜0.001
  PTH 15 (2.8) 10 (2.1) 5 (7.2) 0.010
  CS 3 (0.6) 1 (0.2) 2 (2.9) ＜0.001
  PAS 17 (3.1) 12 (2.5) 5 (7.2) ＜0.001
  MDR-TB 33 (6.1) 18 (3.8) 15 (21.7) 0.001
  XDR-TB 3 (0.6) 0 3 (4.3) 0.001

∗ Resistant to one or more antituberculosis drugs among 15 anti- tuberculosis drugs using in this study.

Abbreviations: New, newly treated patient; Treated, previously treated patient; RFP, rifampin; INH, isoniazid; EMB, ethambutol; PZA, pyrazinamide; RBT, rifabutin; SM, streptomycin; AMK, amikacin; KM, kanamycin; CPM, capreomycin; OFX, ofloxacin; LEV, levofloxacin; MXF, moxifloxacin; PTH, prothionamide; CS, cycloserine; PAS, para-aminosalicylic acid; MDR-TB, multi-drug resistance TB including rifampin and isoniazid resistance; XDR-TB, extensively drug resistance TB.

Table 2.
Anti-tuberculosis drug resistance rates among new and previously treated patients in six hospitals
Hospital Type of patients Total no (%) ≥ One* Conventional drug susceptibility test (% of patients) MDR-TB (%)
RFP (%) INH (%) EMB (%) PZA (%) RBT (%)
SMC, Seoul Total 74 18 (24.3) 8 (10.8) 14 (18.9) 5 (6.8) 4 (5.4) 6 (8.1) 7 (9.5)
 New 73 (98.6) 17 (23.3) 7 (9.6) 13 (17.8) 4 (5.5) 3 (4.1) 5 (6.8) 6 (8.2)
 Treated 1 (1.4) 1 (100) 1 (100) 1 (100) 1 (100) 1 (100) 1 (100) 1 (100)
CMCS, Seoul Total 93 16 (17.2) 8 (8.7) 10 (10.8) 3 (3.2) 5 (5.4) 4 (4.3) 6 (6.5)
 New 79 (84.9) 8 (10.1) 2 (2.5) 4 (5.1) 0 2 (2.5) 1 (1.3) 4 (2.4)
 Treated 14 (15.1) 8 (57.1) 6 (42.9) 6 (42.9) 3 (21.4) 3 (21.4) 3 (21.4) 2 (14.3)
EWUH, Seoul Total 97 11 (11.3) 4 (4.1) 10 (10.3) 3 (3.1) 2 (2.1) 4 (4.1) 3 (3.1)
 New 82 (84.5) 8 (9.8) 2 (2.4) 8 (9.8) 2 (2.4) 1 (1.2) 1 (1.2) 2 (2.4)
 Treated 15 (15.5) 3 (20.0) 2 (13.3) 2 (13.3) 1 (6.7) 1 (6.7) 3 (20.0) 1 (6.7)
CMCD, Daejeon Total 100 10 (10.0) 2 (2.0) 7 (7.0) 0 1 (1.0) 1 (1.0) 1 (1.0)
 New 88 (88.0) 7 (8.0) 1 (1.1) 4 (4.5) 0 1 (1.1) 1 (1.1) 0
 Treated 12 (12.0) 3 (25.0) 1 (8.3) 3 (25.0) 0 0 0 1 (8.3)
PNUH, Busan Total 90 26 (28.9) 15 (16.7) 21 (23.3) 12 (13.3) 8 (8.9) 12 (13.3) 14 (15.6)
 New 79 (87.8) 19 (24.1) 9 (11.4) 15 (19.0) 7 (8.9) 4 (5.1) 8 (10.1) 8 (10.1)
 Treated 11 (12.2) 7 (63.6) 6 (54.5) 6 (54.5) 5 (45.5) 4 (36.4) 4 (36.4) 6 (54.5)
CNUH, Gwangju Total 88 17 (19.3) 2 (2.3) 12 (13.6) 2 (2.3) 1 (1.1) 2 (2.3) 2 (2.3)
 New 72 (81.8) 10 (13.9) 0 5 (6.9) 0 0 0 0
 Treated 16 (18.2) 7 (43.8) 2 (12.5) 7 (43.8) 7 (43.8) 2 (12.5) 1 (6.3) 2 (12.5)

∗ Resistant to one or more antituberculosis drugs among 15 antituberculosis drugs using in this study.

Abbreviations: New, newly treated patient; Treated, previously treated patient; RFP, rifampin; INH, isoniazid; EMB, ethambutol; PZA, pyrazinamide; RBT, rifabutin; MDR-TB, multi-drug resistance TB including rifampin and isoniazid resistance; SMC, Samsung Medical Center; CMCS, Seoul St. Mary's Hospital, The Catholic University of Korea; EWUH, Ewha Womans University Mokdong Hospital; CMCD, Daejeon St. Mary's Hospital, The Catholic University of Korea; PNUH, Pusan National University Yangsan Hospital; CNUH, Chonnam National University Hospital.

Table 3.
The second-line antituberculosis drugs among newly and previously treated patients in six hospitals
Hospital Type of patients Total no (%) Conventional drug susceptibility test (% of patients
SM (%) KM (%) AMK (%) CPM (%) OFX (%) LEV (%) MXF (%) PTH (%) CS (%) PAS (%)
SMC, Seoul Total 74 5 (6.8) 1 (1.4) 1 (1.4) 1 (1.4) 4 (5.4) 4 (5.4) 3 (4.1) 2 (2.7) 0.0 5 (6.8)
  New 73 (98.6) 4 (5.5) 0 0 0 3 (4.1) 3 (4.1) 2 (2.7) 1 (2.7) 0.0 4 (5.5)
  Treated 1 (1.4) 1 (100) 1 (100) 1 (100) 1 (100) 1 (100) 1 (100) 1 (100) 1 (100) 1 (100) 1 (100)
CMCS, Seoul Total 93 9 (9.7) 2 (2.2) 2 (2.2) 1 (1.1) 5 (5.4) 5 (5.4) 3 (3.2) 3 (3.2) 1 (1.1) 2 (2.2)
  New 79 (84.9) 5 (6.3) 0 0 0 0 0 0 1 (1.3) 1 (1.3) 1 (1.3)
  Treated 14 (15.1) 4 (28.6) 2 (14.3) 2 (14.3) 1 (7.1) 5 (35.7) 5 (35.7) 3 (21.4) 2 (14.3) 0 1 (7.1)
EWUH, Seoul Total 97 2 (2.1) 0 0 0 1 (1.0) 1 (1.0) 0 1 (1.0) 0 1 (1.0)
  New 82 (84.5) 1 (1.2) 0 0 0 0 0 0 0 0 0
  Treated 15 (15.5) 1 (6.7) 0 0 0 1 (6.7) 1 (6.7) 0 1 (6.7) 0 1 (6.7)
CMCD, Daejeon Total 1 100 4 (4.0) 0 0 0 0 0 0 0 0 1 (1.0)
  New 88 (88.0) 4 (4.5) 0 0 0 0 0 0 0 0 1 (1.1)
  Treated 12 (12.0) 0 0 0 0 0 0 0 0 0 0
PNUH, Busan Total 90 8 (8.9) 2 (2.2) 2 (2.2) 2 (2.2) 6 (6.7) 6 (6.7) 4 (4.4) 9 (10.0) 1 (1.1) 7 (7.8)
  New 79 (87.8) 6 (7.6) 1 (1.3) 1 (1.3) 1 (1.3) 3 (3.8) 3 (3.8) 2 (2.5) 7 (8.9) 0 6 (7.6)
  Treated 11 (12.2) 2 (18.2) 1 (9.1) 1 (9.1) 1 (9.1) 3 (27.3) 3 (27.3) 2 (18.2) 2 (18.2) 1 (9.1) 1 (9.1)
CNUH, Gwangju Total 88 9 (9.1) 0 0 0 3 (3.4) 3 (3.4) 4 (4.5) 0 1 (1.1) 1 (1.1)
  New 72 (81.8) 7 (8.3) 0 0 0 1 (1.4) 1 (1.4) 1 (1.4) 0 0 0
  Treated 16 (18.2) 2 (12.5) 0 0 0 2 (12.5) 2 (12.5) 3 (18.8) 0 1 (6.3) 1 (6.3)

Abbreviations: New, newly treated patient; Treated, previously treated patient; SM, streptomycin; KM, kanamycin; AMK, amikacin; CPM, capreomycin; OFX, ofloxacin; LEV, levofloxacin; MXF, moxifloxacin; PTH, prothionamide; CS, cycloserine; PAS, para-aminosalicylic acid; SMC, Samsung Medical Center; CMCS, Seoul St. Mary's Hospital, The Catholic University of Korea; EWUH, Ewha Womans University Mokdong Hospital; CMCD, Daejeon St. Mary's Hospital, The Catholic University of Korea; PNUH, Pusan National University Yangsan Hospital; CNUH, Chonnam National University Hospital.

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