Multidrug-resistant tuberculosis in South Korea: a retrospective analysis of national registry data in 2011–2015

Lee, M.; Han, Jae Joon; Kim, Y. R.; Kwak, Nakwon; Kim, J. H.; Park, O.; Shin, Sang Sook; Moon, Hwa Sik; Kim, H. J.; Jang, Miso; Yim, Jae Joon

doi:10.5588/ijtld.18.0658

Cited by 18 publications

(17 citation statements)

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“…Second, PPM should be expanded. The loss to follow-up of MDR-TB patients was significantly lower than the national rate in both our hospital and another South Korean PPM hospital 19,26 . MDR-TB patients could be referred to PPM hospitals.…”

Section: Discussionmentioning

confidence: 52%

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Treatment Outcomes of Patients with Multidrug-Resistant Tuberculosis: Comparison of Pre- and Post-Public–Private Mix Periods

Kang

Eom

et al. 2021

Tuberc Respir Dis

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Background This study compared the treatment outcomes of patients with multidrug-resistant tuberculosis (MDR-TB) before and after the implementation of public–private mix (PPM). Factors affecting treatment success were also investigated. Methods Data from culture-confirmed pulmonary MDR-TB patients who commenced MDR-TB treatment at Pusan National University Hospital between January 2003 and December 2017 were retrospectively reviewed. Patients were divided into two groups in terms of PPM status: pre-PPM period, patients who commenced MDR-TB treatment between 2003 and 2010; and post-PPM period, patients treated between 2011 and 2017. Results A total of 176 patients were included (64 and 112 in the pre- and post-PPM periods, respectively). 36.9% of the patients were resistant to a fluoroquinolone or a second-line injectable drug, or both. The overall treatment success rate was 72.7%. The success rate of post-PPM patients was higher than that of pre-PPM patients (79.5% vs. 60.9%, p=0.008). Also, loss to follow-up was lower in the post-PPM period (5.4% vs. 15.6%, p=0.023). In multivariate regression analysis, age ≥65 years, body mass index ≤18.5 kg/m 2 , previous TB treatment, bilateral lung involvement, and extensively drug-resistant (XDR)- or pre-XDR-TB were associated with poorer treatment outcomes. However, the use of bedaquiline or delamanid for ≥1 month increased the treatment success. Conclusion The treatment success rate in MDR-TB patients was higher in the post-PPM period than in the pre-PPM period, particularly because of the low rate of loss to follow-up. To ensure comprehensive patient-centered PPM in South Korea, investment and other support must be adequate.

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Section: Discussionmentioning

confidence: 52%

“…It is well-known that loss to follow-up reduces treatment success in MDR-TB patients in South Korea. A recent study employing national registry data showed that although the trend was decreasing, about 10% of MDR-TB patients are still lost to follow-up annually 19 . In this study, 14% of MDR-TB patients were transferred out during treatment.…”

Section: Discussionmentioning

confidence: 99%

Treatment Outcomes of Patients with Multidrug-Resistant Tuberculosis: Comparison of Pre- and Post-Public–Private Mix Periods

Kang

Eom

et al. 2021

Tuberc Respir Dis

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“…The treatment outcomes of patients with FQ-resistant MDR-TB are poor. 20 21 One of the main reasons for this is the difficulty building an effective treatment regimen due to the high rate of resistance to other drugs. In our study, patients with FQ-resistant MDR-TB had additional resistances to a median of nine drugs.…”

Section: Discussionmentioning

confidence: 99%

Additional Drug Resistance in Patients with Multidrug-resistant Tuberculosis in Korea: a Multicenter Study from 2010 to 2019

Lee

Jeon

et al. 2021

J Korean Med Sci

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Background Drug-resistance surveillance (DRS) data provide key information for building an effective treatment regimen in patients with multidrug-resistant tuberculosis (MDR-TB). This study was conducted to investigate the patterns and trends of additional drug resistance in MDR-TB patients in South Korea. Methods Phenotypic drug susceptibility test (DST) results of MDR-TB patients collected from seven hospitals in South Korea from 2010 to 2019 were retrospectively analyzed. Results In total, 633 patients with MDR-TB were included in the analysis. Of all patients, 361 (57.0%) were new patients. All patients had additional resistance to a median of three anti-TB drugs. The resistance rates of any fluoroquinolone (FQ), linezolid, and cycloserine were 26.2%, 0.0%, and 6.3%, respectively. The proportions of new patients and resistance rates of most anti-TB drugs did not decrease during the study period. The number of additional resistant drugs was significantly higher in FQ-resistant MDR-TB than in FQ-susceptible MDR-TB (median of 9.0 vs. 2.0). Among 26 patients with results of minimum inhibitory concentrations for bedaquiline (BDQ) and delamanid (DLM), one (3.8%) and three (11.5%) patients were considered resistant to BDQ and DLM with interim critical concentrations, respectively. Based on the DST results, 72.4% and 24.8% of patients were eligible for the World Health Organization's longer and shorter MDR-TB treatment regimen, respectively. Conclusion The proportions of new patients and rates of additional drug resistance in patients with MDR-TB were high and remain stable in South Korea. A nationwide analysis of DRS data is required to provide effective treatment for MDR-TB patients in South Korea.

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“…MDR-TB poses a threat to public health as a result of the associated high treatment costs and unsatisfactory outcomes. In South Korea, the treatment success rate for MDR-TB was only 65.7% between 2011 and 2014 [2]. Patients who fail to be cured of MDR-TB have an average life expectancy of 9 years, during which time they are capable of infecting others in the community [3].…”

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confidence: 99%

“…Although Kim et al [4] reported that the rates of fluoroquinolone resistance did not change amozng 378 MDR-TB patients diagnosed between 2010 and 2014, the analysis based on nationwide notification data, including 5,192 patients, revealed a decrease in fluoroquinolone resistance from 34.2% to 16.9% in South Korea between 2011 and 2015 [2]. Further detailed studies are required to explain the persistent rates of fluoroquinolone resistance in Busan, Ulsan, and Gyeongsangnam-do.…”

mentioning

confidence: 99%

Fluoroquinolone resistance in multidrug-resistant tuberculosis patients

Lee

Yim

2019

Korean J Intern Med

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Multidrug-resistant tuberculosis in South Korea: a retrospective analysis of national registry data in 2011–2015

Cited by 18 publications

References 0 publications

Treatment Outcomes of Patients with Multidrug-Resistant Tuberculosis: Comparison of Pre- and Post-Public–Private Mix Periods

Treatment Outcomes of Patients with Multidrug-Resistant Tuberculosis: Comparison of Pre- and Post-Public–Private Mix Periods

Additional Drug Resistance in Patients with Multidrug-resistant Tuberculosis in Korea: a Multicenter Study from 2010 to 2019

Fluoroquinolone resistance in multidrug-resistant tuberculosis patients

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