Tuberculosis and Respiratory Diseases

  • 제84권1호
  • /
  • Pages.74-83
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  • 2021
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  • 1738-3536(pISSN)
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  • 2005-6184(eISSN)
대한결핵및호흡기학회 (The Korean Academy of Tuberculosis and Respiratory Diseases)
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Treatment Outcomes of Patients with Multidrug-Resistant Tuberculosis: Comparison of Pre- and Post-Public-Private Mix Periods

  • Kang, Yewon (Department of Internal Medicine, VHS Medical Center) ;
  • Jo, Eun-Jung (Department of Internal Medicine, Pusan National University Hospital) ;
  • Eom, Jung Seop (Department of Internal Medicine, Pusan National University Hospital) ;
  • Kim, Mi-Hyun (Department of Internal Medicine, Pusan National University Hospital) ;
  • Lee, Kwangha (Department of Internal Medicine, Pusan National University Hospital) ;
  • Kim, Ki Uk (Department of Internal Medicine, Pusan National University Hospital) ;
  • Park, Hye-Kyung (Department of Internal Medicine, Pusan National University Hospital) ;
  • Lee, Min Ki (Department of Internal Medicine, Pusan National University Hospital) ;
  • Mok, Jeongha (Department of Internal Medicine, Pusan National University Hospital)
  • 투고 : 2020.08.08
  • 심사 : 2020.10.28
  • 발행 : 2021.01.31
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초록

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/m2, 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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과제정보

This work was supported by clinical research grant from Pusan National University Hospital in 2020.

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