Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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The Prevalence and Risk Factors of Drug Resistant Pulmonary Tuberculosis Investigated at One University Hospital in Seoul

서울지역 한 대학병원에서 조사된 폐결핵 약제 내성률 및 위험인자

  • Kim, Do Kyun (National Medical Center) ;
  • Kim, Mi Ok (Department of Internal Medicine, JeJu Medical School) ;
  • Kim, Tae-Hyung (Department of Internal Medicine, Hanyang University Medical School) ;
  • Sohn, Jang Won (Department of Internal Medicine, Hanyang University Medical School) ;
  • Yoon, Ho Joo (Department of Internal Medicine, Hanyang University Medical School) ;
  • Shin, Dong Ho (Department of Internal Medicine, Hanyang University Medical School) ;
  • Park, Sung Soo (Department of Internal Medicine, Hanyang University Medical School)
  • 김도균 (국립의료원) ;
  • 김미옥 (제주대학교 의과대학 내과학교실) ;
  • 김태형 (한양대학교 의과대학 내과학교실) ;
  • 손장원 (한양대학교 의과대학 내과학교실) ;
  • 윤호주 (한양대학교 의과대학 내과학교실) ;
  • 신동호 (한양대학교 의과대학 내과학교실) ;
  • 박성수 (한양대학교 의과대학 내과학교실)
  • Received : 2004.10.28
  • Accepted : 2005.01.25
  • Published : 2005.03.30
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Abstract

Background : The prevalence of tuberculosis is slowly decreasing in Korea. However, the drug-resistance of pulmonary tuberculosis is a major risk factor of treatment failure. Moreover, the National Surveillance System has recently been discontinued. Therefore, a continuous survey is necessary for the exact detection of the rate of drug resistance. We studied the recent 4-year drug resistance rate of tuberculosis at a single University hospital in Seoul. Materials and Methods : The study included 239 pulmonary tuberculosis patients performed with a tuberculosis culture and a drug-sensitivity test at Hanyang University Medical Center from March 1999 to March 2003. Results : Of the 239 patients included in the study during the 4-year period, 52 patients showed resistance to one or more anti-tuberculosis drug (21.8%). The rate of multi-drug resistance was 12.6%. The resistance rates to isoniazid, rifampin, ethambutol, streptomycin and pyrazinamide were 18.4%, 13.8%, 11.7%, 6.7% and 8.4%, respectively. Ninety patients had a history of previous anti-tuberculosis treatment, and the rates of the overall drug resistance and multi-drug resistance of these patients were 36.7% and 25.6%, respectively. The patients with drug-resistance showed a higher rate of a previous tuberculosis treatment history (63.5%) than the drug-sensitive group patients (30.5%). Conclusion : The rate of drug resistant tuberculosis is 21.8%, and multi-drug resistant tuberculosis is 12.6%. The rate of drug resistance is higher in those previously treated for tuberculosis.

연구배경 : 한국에서 결핵환자의 유병률은 지속적으로 감소하고 있으나 약제에 대한 내성은 치료 실패의 중요한 요인이다. 국가적인 조사가 시행되지 않는 현 시점에서 지속적인 내성률 조사가 더욱 필요하다. 이에 저자들은 최근 4년간 서울 소재 한 대학병원에서 조사된 결핵균의 내성률 및 관련된 위험인자를 조사하였다. 대상 및 방법 : 1999년 3월부터 2003년 3월까지 한양대학교 의료원에서 치료 받은 결핵환자 중 결핵 배양 및 감수성 검사를 시행한 239명을 대상으로 하였다. 결 과 : 239명 중 한가지 이상의 약제에 내성을 보인 경우는 25명(21.8%)였고, 다제 내성 결핵은 30명(12.6%)이었다. INH, RFP, EMB, SM, PZA의 내성률은 각각 18.4%, 13.8%, 11.7%, 6.7%, 8.4%였다. 과거 결핵 치료력이 있는 환자는 90명이었으며 이들 중 약제 내성률은 36.7%, 다제 내성률은 25.6%였다. 약제 내성을 보인 환자의 63.5%는 과거 치료력이 있었으며 약제 감수성군의 과거 치료력은 30.5%였다. 결 론 : 서울에 소재한 한 대학병원에서 조사된 결핵 내성률은 21.8%, 다제 내성 결핵의 비율은 12.6%였다. 과거 결핵 치료력이 있는 경우에 약제 내성률이 높았다.

Keywords

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