PURPOSE: Although the prevalence of pulmonary tuberculosis has progressively decreased all over the world, drug resistant tuberculosis is one the major obstacles in treating pulmonary tuberculosis. We compared the current prevalence of multi-drug resistant (MDR) and prognostic factor for the MDR with ten years ago at the tertiary referral hospital of Korea, where pulmonary tuberculosis is intermediate endemic.
METHODS: This study consisted of 373 active pulmonary tuberculosis patients underwent mycobacterium culture and drug sensitivity test between January 2005 and December 2009. The prevalence and characteristics of drug resistance were retrospectively compared with those of 138 patients between May 1995 and June 1999. MDR and extensive drug resistance (XDR) were defined as resistance to isoniazide (INH), rifampin (RFP) and INH, RFP, injectable aminoglycoside, fluoroquinolone, respectively.
RESULTS: Among 373 patients, 77(20.0%) patients showed resistance to at least one drug. INH (18.2%) was most frequent resistant drug and followed by RFP (10.7%), ethambutol (7.0%), streptomycin (5.2%), and fluoroquinolone (2.6%). Resistance to second-line drugs was found in 38(9.9%) patients. The MDR and XDR was evident in 40(10.4%) and 4(1.0%) patients, respectively. The current prevalence of MDR was significantly lower as compared with that of past period (10.4% vs. 24.6%, p< 0.01). Previous treatment was prognostic factor for the MDR (OR: 8.1, 95% CI: 3.9 ~ 16.7, p< 0.001). Previous treatment was also associated with the MDR in the past cohort.
CONCLUSION: The current rate of MDR has much decreased in intermediate endemism country; however, previous treatment remains as independent risk factor of MDR.
CLINICAL IMPLICATIONS: A careful management is needed for patients with history of previous treatment.
DISCLOSURE: Soo-Jung Um, No Financial Disclosure Information; No Product/Research Disclosure Information