Extensively Drug‐Resistant Tuberculosis in South Korea: Risk Factors and Treatment Outcomes among Patients at a Tertiary Referral Hospital

• Published in: Clinical infectious diseases Vol. 46; no. 1; pp. 42 - 49
• Main Authors: Jeon, Christie Y., Hwang, Soo Hee, Min, Jin Hong, Prevots, D. Rebecca, Goldfeder, Lisa C., Lee, Hyeyoung, Eum, Seok Yong, Jeon, Doo Soo, Kang, Hyung Seok, Kim, Jin Hee, Kim, Byoung Ju, Kim, Dae Yeon, Holland, Steven M., Park, Seung Kyu, Cho, Sang Nae, Barry, Clifton E., Via, Laura E.
• Format: Journal Article
• Language: English
• Published: Chicago, IL The University of Chicago Press 01-01-2008; University of Chicago Press; Oxford University Press
• Subjects: Adult; Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antitubercular Agents - therapeutic use; Antituberculars; Articles and Commentaries; Bacterial diseases; Biological and medical sciences; Clinical outcomes; Cohort Studies; Drug resistance; Drug therapy; Extensively Drug-Resistant Tuberculosis - drug therapy; Extensively Drug-Resistant Tuberculosis - epidemiology; Extensively Drug-Resistant Tuberculosis - microbiology; Female; Fluoroquinolones; Fluoroquinolones - pharmacology; Fluoroquinolones - therapeutic use; Hospitalization; Human bacterial diseases; Humans; Infectious diseases; Korea - epidemiology; Male; Medical sciences; Multidrug resistant tuberculosis; Multivariate analysis; Mycobacterium; Mycobacterium tuberculosis; Pharmacology. Drug treatments; Prescription drugs; Prospective Studies; Pulmonary tuberculosis; Risk Factors; Sex Factors; Sputum; Treatment Outcome; Tuberculosis; Tuberculosis and atypical mycobacterial infections; Asia; South Korea; Korea; Human; Prognosis; Streptomycin; Mycobacterial infection; Ofloxacin; Epidemiology; Infection; Resistance; Antibiotic; Treatment; Tuberculosis; Multiple resistance; Risk factor; Bacteriosis; Kanamycin; Hospital; Antibacterial agent; Predictive factor; Public health
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1086/524017

Background. Extensively drug‐resistant (XDR) tuberculosis (TB) is a major public health threat in South Korea. Methods. We analyzed baseline epidemiological data for 250 patients enrolled in an ongoing prospective observational study of TB at a large tertiary referral hospital in South Korea. Results. Twenty‐six subjects with XDR TB were identified; all were patients who had previously received TB therapy. Cumulative previous treatment duration (range, 18–34 months; odds ratio [OR], 5.6; 95% confidence interval [CI], 1.0–59), number of previously received second‐line anti‐TB drugs (OR, 1.3; 95% CI, 1.1–1.5), and female sex (OR, 3.2; 95% CI, 1.1–8.3) were significantly associated with XDR TB in crude analyses. After controlling for other factors in a multivariable model, cumulative previous treatment duration remained significantly associated with XDR TB (OR, 5.8; 95% CI, 1.0–61). Subjects with XDR TB were more likely to produce culture‐positive sputum at 6 months, compared with patients with non—multidrug resistant TB (risk ratio, 13; 95% CI, 5.1–53). Kanamycin resistance was found to be predictive of 6‐month culture positivity after adjustment for ofloxacin and streptomycin resistance (risk ratio, 3.9; 95% CI, 1.9–11). Conclusions. XDR TB was found to be associated with the cumulative duration of previous treatment with second‐line TB drugs among subjects in a tertiary care TB hospital. Patients with XDR TB were more likely to not respond to therapy, and successful conversion of sputum culture results to negative was correlated with initial susceptibility to both fluoroquinolones and kanamycin but not to streptomycin.