Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
권호 표지

The Clinical Characteristics, Diagnosis, Treatment, and Outcomes of Patients with Tuberculosis at a Private University Hospital in Korea

국내 한 민간종합병원에서 결핵 환자의 진료 실태

  • Jung, Young Ju (Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Park, I-Nae (Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Hong, Sang Bum (Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Oh, Yeon-Mok (Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Lim, Chae-Man (Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Lee, Sang Do (Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Koh, Younsuck (Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Kim, Woo Sung (Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Kim, Dong Soon (Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Kim, Won Dong (Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Shim, Tae Sun (Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center)
  • 정영주 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 박이내 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 홍상범 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 오연목 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 임채만 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 이상도 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 고윤석 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 김우성 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 김동순 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 김원동 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 심태선 (울산대학교 의과대학 서울아산병원 호흡기내과)
  • Received : 2005.12.01
  • Accepted : 2006.01.31
  • Published : 2006.02.28
Download PDF
⟨ Previous Next ⟩

Abstract

Background : Even though tuberculosis (TB) is still a major public concern in Korea, there is little data on the management of TB patients and its outcomes in the private sector. This study evaluated the status of TB treatment in the private sector. Methods : Sixteen-hundred-sixty-six TB patients who were notified in a private university hospital from 2001 to 2002 were enrolled in this study. The patients were divided into pulmonary ($TB_P$), extrapulmonary ($TB_E$), and combined ($TB_{P+E}$) groups, and were also divided into initial and retreatment groups. The clinical characteristics, diagnostic methods, treatment regimens, and outcomes were analyzed and compared. Results : The mean age of the 1,666 patients was 48.9 years and the male-to-female ratio was 1.3:1. The number of patients in the initial and retreatment groups of $TB_P$, and those of ($TB_E+TB_{P+E}$) were 809, 276, 480, 101, respectively. A bacteriological study was performed in 92.0% of cases, and a positive culture was confirmed in 58.1% and 31.7% of patients with TBP and ($TB_E+TB_{P+E}$), respectively (p<0.05). The AFB smear was positive in 45.4 % of the $TB_P$ patients. PCR was carried out in 60.4% of the ($TB_E+TB_{P+E}$) group. The MDR was detected in 14.0% of isolates. Overall, the treatment completion, default, and death rates were 70.2%, 13.5% and 1.9%, respectively. Conclusion : Even though the management of TB patients in a private hospital was satisfactory in terms of the national guidelines, the high default rate was is still a problem. Efforts to decrease the default rate either independently or in cooperation with the public sector will be needed.

연구 배경 : 결핵은 아직도 우리나라에서 보건학적으로 중요한 문제임에도 불구하고 공공의료부문과 달리 민간의료부문에서의 결핵 환자 진료 실태는 잘 알려져 있지 않은 상황이다. 국내 민간 병원에서의 결핵환자 진료 실태를 파악하고자 본 연구를 시행하게 되었다. 방 법 : 2001년에서 2002년 사이에 결핵정보감시체계에 등록된 15세 이상의 결핵 환자 1,819명 중 결핵이 아닌 사람 153명을 제외한 1,666명을 대상으로 후향적으로 의무기록을 분석하였다. 환자를 폐결핵과 폐외결핵, 초치료군과 재치료군으로 나누어 임상상, 진단방법, 약제감수성 검사 결과, 치료처방, 약제부작용 및 치료결과를 분석하였다. 결 과 : 1,666명의 평균 나이는 48.9세, 남녀비는 1.3:1이었다. 폐결핵 초치료 및 재치료, 폐외결핵 초치료 및 재치료 환자는 각각 809, 276, 480, 101명이었고, 26.2%(437명) 에서 기저질환이 동반되었다. 92.0% (1,532명)에서 세균학적 검사가 시행되었고 배양 양성은 폐결핵에서 58.1%(630명), 폐외결핵에서 31.7% (184명)이었다 (p<0.05). 도말 양성 폐결핵은 45.4% (493/1,085)이었다. 결핵균 PCR은 폐결핵의 16.2%, 폐외결핵의 60.4%에서 시행되었으며 양성률은 전체 환자 중 각각 5.9%와 29.8%이었다(p<0.05). 다제내성 결핵은 14.0% (68/485)에서 확인되었다. 전체 환자의 치료완료율은 70.2%이었고, 배양 양성 폐결핵 환자에서의 완치율 및 치료완료율은 각각 49.4%와 65.6%이었다. 전체 환자의 치료중단율은 13.5%, 사망률은 1.9%이었다. 결 론 서울 소재 한 민간대학병원에서의 결핵의 진단 및 치료는 국내 결핵관리지침에 부합할 뿐만 아니라 새로운 진단기법의 도입 등 만족할 만하였으나 중도 탈락 환자를 관리하지 못하는 단점이 확인되었다. 추후 중도 탈락 환자를 관리할 수 있는 방법의 개발이 필요하다. 다양한 치료기간의 원인에 대하여는 추후 분석이 필요하다.

Keywords

References

  1. Ministry of Health and Welfare KNTA. Report on the 7th tuberculosis prevalence survey in Korea. Seoul:Ministry of Health and Welfare, Korean National Tuberculosis Association 1996
  2. Lew WJ. Tuberculosis surveillance system in Korea. Tuberc Respir Dis 2000;48:298-307 https://doi.org/10.4046/trd.2000.48.3.298
  3. Lee EK. Situation of incidence of tuberculosis in Korea. Communica Dis Month Rep 2003;14:359-67
  4. Bai GH. Anti-tuberculosis drug resistance in Korea. Communica Dis Month Rep 2005;16: 101-7
  5. Korea National Statistical Office. Annual statistics of causes of mortality 2004. Seoul: Korea National Statistical Office 2005
  6. Korea Center for Disease Control and Prevention, Korean Institute of Tuberculosis. Annual report on the notified tuberculosis patients in Korea. Seoul:Korea Center for Disease Control and Prevention, Korean Institute of Tuberculosis 2005
  7. Koh WJ, Kwon OJ, Kim CH, Ahn YM, Lim SY, Yun JW, et al. Clinical characteristics and treatment outcomes of patients with pulmonary tuberclosis at a private general hospital. Tuberc Respir Dis 2003;55:154-64 https://doi.org/10.4046/trd.2003.55.2.154
  8. Park KD. Tuberculosis management of private health care institution: current situation and task. Tuberc Respir Dis 2002;52:579-89 https://doi.org/10.4046/trd.2002.52.6.579
  9. Jin BW, Jang DJ. An analysis of tuberculosis management in private sector. Tuberc Respir Dis 1990;37:399-406
  10. Hong YP, Kim SJ, Lee EG, Lew WJ, Bai JY. Treatment of bacillary pulmonary tuberculosis at the chest clinics in the private sector in Korea, 1993. Int J Tuberc Lung Dis 1999;3:695-702
  11. American Thoracic Society / Center for Disease Control and Prevention. Diagnostic standards and classification of tuberculosis in adults and children. Am J Respir Crit Care Med 2000;161:1376-95 https://doi.org/10.1164/ajrccm.161.4.16141
  12. World Health Organization. Treatment of tuberculosis: guidelines for national programmes. 3rd ed. Geneva, Switzerland: WHO; 2003
  13. Korean Academy of Tuberculosis and Respiratory Diseases. Guideline for the management of pulmonary tuberculosis, 1997. Tuberc Respir Dis 1997;44:1447-53
  14. Kim CH, Koh WJ, Kwon OJ, Ahn YM, Lim SY, An CH, et al. The accuracy of tuberculosis notification reports at a private general hospital after enforcement of new Korean Tuberculosis Surveillance System. Tuberc respir Dis 2003;54:178-90 https://doi.org/10.4046/trd.2003.54.2.178
  15. Hong YP, Kim SJ, Kwon DW, Chang SC, Lew WJ, Han YC. The sixth Nationwide Tuberculosis Prevalence Survey in Korea, 1990. Tuber Lung Dis 199 3;74:323-31 https://doi.org/10.1016/0962-8479(93)90107-9
  16. Hong YP, Kwon DW, Kim SJ, Chang SC, Kang MK, Lee EP, et al. Survey of knowledge, attitudes and practices for tuberculosis among general practitioners. Tuber Lung Dis 1995;76:431-5 https://doi.org/10.1016/0962-8479(95)90010-1
  17. National Institution of Health. Guideline of the control of tuberculosis. Seoul: National Institution of Health 2003
  18. Korean Academy of Tuberculosis and Respiratory Diseases. Guideline for the management of tuberculosis. Seoul: Korean Academy of Tuberculosis and Respiratory Diseases; 2005
  19. Bass JB Jr, Farer LS, Hopewell PC, O'Brien R, Jacobs RF, Ruben F, et al. Treatment of tuberculosis and tuberculosis infection in adults and children. Am J Respir Crit CareMed 1994;149:1359-74 https://doi.org/10.1164/ajrccm.149.5.8173779
  20. Blumberg HM, Burman WJ, Chaisson RE, Daley CL, Etkind SC, Friedman LN, et al. American Thoracic Society/Centers for Disease Control and Prevention/ Infectious Diseases Society of America: treatment of tuberculosis. Am J Respir Crit Care Med 2003;167:603-62 https://doi.org/10.1164/rccm.167.4.603
  21. Lew WJ, Kim SJ, Kim HJ, Lee EG, Kang MK, Bai JK. The treatment outcomes of 'defaulted' or 'transferred out' tuberculosis patients in Korea. Tuberculosis Surveillance Research Unit Pregress Report 2001:137-50
  22. Hong YP, Kim SJ, Lew WJ, Lee SH, Lee EK. Cohort analyses of the treatment of smear-positive pulmonary tuberculosis patients under programme conditions in Korea, 1983-1994. Int J Tuberc Lung Dis 1998;2:365-71
  23. Yum HK, Song YS, Jeon SY, Choi SJ, Lee BC, Kim DS. The incidence of drug resistant tuberculosis in 1279 Korean patients. Korean J Intern Med 1995;10:38-42 https://doi.org/10.3904/kjim.1995.10.1.38
  24. Lee JH, Chang JH. Drug-resistant tuberculosis in a tertiary referral teaching hospital of Korea. Korean J Intern Med 2001;16:173-9 https://doi.org/10.3904/kjim.2001.16.3.173
  25. Kim SY, Jeong SS, Kim KW, Shin KS, Park SG, Kim AK, et al. Drug-resistant pulmonary tuberculosis in a tertiary referral hospital in Korea. Korean J Intern Med 1999;14:27-31
  26. Yum HK, Choi SJ, Lee BC, Kim DS. Treatment results of multidrug resistant tuberculosis in a university hospital in Korea. Tuberc Respir Dis 1996;43:862-8 https://doi.org/10.4046/trd.1996.43.6.862
  27. Park SK, Kim CT, Song SD. Outcome of chemotherapy in 107 patients with pulmonary tuberculosis resistant to isoniazid and rifampin. Int J Tuberc Lung Dis 1998;2:877-84
  28. Park SK, Lee WC, Lee DH, Mitnick CD, Han L, Seung KJ. Self-administered, standardized regimens for multidrug-resistant tuberculosis in South Korea. Int J Tuberc Lung Dis 2004;8:361-8
  29. Kim HJ, Hong YP, Kim SJ, Lew WJ, Lee EG. Ambulatory treatment of multidrug-resistant pulmonary tuberculosis patients at a chest clinic. Int J Tuberc Lung Dis 2001;5:1129-36
  30. Chan ED, Laurel V, Strand MJ, Chan JF, Huynh ML, Goble M, et al. Treatment and outcome analysis of 205 patients with multidrug-resistant tuberculosis. Am J Respir Crit Care Med 2004;169:1103-9 https://doi.org/10.1164/rccm.200308-1159OC