Treatment Outcomes and Prognostic Factors in Patients with Multidrug-Resistant Tuberculosis in Korean Private Hospitals

Park, Jin Kyeong; Koh, Won Jung; Kim, Deog Kyeom; Kim, Min Jung; Kim, Yu Il; Kim, Hee Jin; Kim, Tae Hyung; Kim, Jae Yeol; Park, Moo Suk; Park, I Nae; Park, Jae Seuk; Lee, Ki Man; Song, Sook Hee; Lee, Jin Hwa; Lee, Seung Heon; Lee, Hyuk Pyo; Yim, Jae Joon; Lim, Jae‐Min; Jegal, Yangjin; Jung, Ki Hwan; Huh, Jin Won; Choi, Jae Chol; Shim, Tae Sun

doi:10.4046/trd.2010.69.2.95

Cited by 8 publications

(5 citation statements)

References 11 publications

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“…In our study cohort, only 50.3% of MDR-TB patients could fulfill these eligibility criteria. In Korea, high levels of drug resistance have already been reported in several retrospective MDR-TB cohort studies ( 11 , 14 - 17 ); additional resistance to PZA, OFX, and KM was 26.2%–59.0%, 16.6%–47.5%, and 13.3%–25.0% respectively. Considering high levels of additional drug resistance, it may not be appropriate to adopt the shorter MDR-TB regimen as a general strategy for MDR-TB treatment in Korea.…”

Section: Discussionmentioning

confidence: 79%

Additional Drug Resistance Patterns among Multidrug-Resistant Tuberculosis Patients in Korea: Implications for Regimen Design

et al. 2017

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Detailed information on additional drug resistance patterns of multidrug-resistant tuberculosis (MDR-TB) is essential to build an effective treatment regimen; however, such data are scarce in Korea. We retrospectively analyzed the results of phenotypic drug susceptibility testing (DST) of culture confirmed-TB patients from January 2010 to December 2014 in 7 university hospitals in Korea. MDR-TB was identified among 6.8% (n = 378) of 5,599 isolates. A total of 57.1% (n = 216) of the MDR-TB patients had never been treated for TB. Strains from MDR-TB patients showed additional resistance to pyrazinamide (PZA) (35.7%), any second-line injectable drug (19.3%), and any fluoroquinolone (26.2%). Extensively drug resistant TB comprised 12.4% (n = 47) of the MDR-TB patients. Of 378 MDR-TB patients, 50.3% (n = 190) were eligible for the shorter MDR-TB regimen, and 50.0% (n = 189) were fully susceptible to the 5 drugs comprising the standard conventional regimen (PZA, kanamycin, ofloxoacin, prothionamide, and cycloserine). In conclusion, the proportion of new patients and the levels of additional drug resistance were high in MDR-TB patients. Considering the high levels of drug resistance, the shorter MDR-TB treatment regimen may not be feasible; instead, an individually tailored regimen based on the results of molecular and phenotypic DST may be more appropriate in MDR-TB patients in Korea.

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Section: Discussionmentioning

confidence: 79%

Additional Drug Resistance Patterns among Multidrug-Resistant Tuberculosis Patients in Korea: Implications for Regimen Design

et al. 2017

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“…1411 hits were excluded during title and abstract screening. Sixty-four references were thus identified for full text review and all were retrieved [ 3 , 8 – 70 ] (Fig. 1 ).…”

Section: Resultsmentioning

confidence: 99%

The effect of early versus late treatment initiation after diagnosis on the outcomes of patients treated for multidrug-resistant tuberculosis: a systematic review

et al. 2016

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BackgroundGlobally it is estimated that 480 000 people developed multidrug-resistant tuberculosis (MDR-TB) in 2014 and 190 000 people died from the disease. Successful treatment outcomes are achieved in only 50 % of patients with MDR-TB, compared to 86 % for drug susceptible disease. It is widely held that delay in time to initiation of treatment for MDR-TB is an important predictor of treatment outcome. The objective of this review was to assess the existing evidence on the outcomes of multidrug- and extensively drug-resistant tuberculosis patients treated early (≤4 weeks) versus late (>4 weeks) after diagnosis of drug resistance.MethodsEight sources providing access to 17 globally representative electronic health care databases, indexes, sources of evidence-based reviews and grey literature were searched using terms incorporating time to treatment and MDR-TB. Two-stage sifting in duplicate was employed to assess studies against pre-specified inclusion and exclusion criteria. Only those articles reporting WHO-defined treatment outcomes were considered for inclusion. Articles reporting on fewer than 10 patients, published before 1990, or without a comparison of outcomes in patient groups experiencing different delays to treatment initiation were excluded.ResultsThe initial search yielded 1978 references, of which 1475 unique references remained after removal of duplicates and 28 articles published pre-1990. After title and abstract sifting, 64 papers underwent full text review. None of these articles fulfilled the criteria for inclusion in the review.ConclusionsWhilst there is an inherent logic in the theory that treatment delay will lead to poorer treatment outcomes, no published evidence was identified in this systematic review to support this hypothesis. Reports of programmatic changes leading to reductions in treatment delay exist in the literature, but attribution of differences in outcomes specifically to treatment delay is confounded by other contemporaneous changes. Further primary research on this question is not considered a high priority use of limited resources, though where data are available, improved reporting of outcomes by time to treatment should be encouraged.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1524-0) contains supplementary material, which is available to authorized users.

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“…High levels of drug resistance in South Korea have been reported in several retrospective MDR-TB cohort studies. Additional resistance to pyrazinamide, ofloxacin, and kanamycin was 26.2%–59%, 16.6%–47.5%, and 13.3%–25%, respectively 3 8 9 10 11 . A recent regional survey of drug resistance in South Korea demonstrated that strains from MDR-TB patients had additional resistance to pyrazinamide (35.7%), fluoroquinolones (26.2%), and second-line injectable drugs (19.3%) 53 .…”

Section: Summary Of Major Changes In the 2016 Guidelinesmentioning

confidence: 99%

“…In 2016, a total of 852 MDR-TB, and 59 extensively drug-resistant TB cases were notified 4 . Until 2011, the published successful treatment rate of MDR-TB patients in South Korea varied from 37.1% to 66.0% 5 6 7 8 9 10 11 . However, the largest retrospective multicenter study (n=1,407 MDR-TB patients) showed a treatment success rate of 45.3% and a default rate of 32.3% 9 .…”

Section: Introductionmentioning

confidence: 99%

WHO Treatment Guidelines for Drug-Resistant Tuberculosis, 2016 Update: Applicability in South Korea

Jeon

2017

Tuberc Respir Dis

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Despite progress made in tuberculosis control worldwide, the disease burden and treatment outcome of multidrug-resistant tuberculosis (MDR-TB) patients have remained virtually unchanged. In 2016, the World Health Organization released new guidelines for the management of MDR-TB. The guidelines are intended to improve detection rate and treatment outcome for MDR-TB through novel, rapid molecular testing and shorter treatment regimens. Key changes include the introduction of a new, shorter MDR-TB treatment regimen, a new classification of medicines and updated recommendations for the conventional MDR-TB regimen. This paper will review these key changes and discuss the potential issues with regard to the implementation of these guidelines in South Korea.

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Treatment Outcomes and Prognostic Factors in Patients with Multidrug-Resistant Tuberculosis in Korean Private Hospitals

Cited by 8 publications

References 11 publications

Additional Drug Resistance Patterns among Multidrug-Resistant Tuberculosis Patients in Korea: Implications for Regimen Design

Additional Drug Resistance Patterns among Multidrug-Resistant Tuberculosis Patients in Korea: Implications for Regimen Design

The effect of early versus late treatment initiation after diagnosis on the outcomes of patients treated for multidrug-resistant tuberculosis: a systematic review

WHO Treatment Guidelines for Drug-Resistant Tuberculosis, 2016 Update: Applicability in South Korea

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