Extensively drug-resistant tuberculosis in South Korea: risk factors and treatment outcomes among patients at a tertiary referral hospital.
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.
Jeon
Christie Y
CY
Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA.
Hwang
Soo Hee
SH
Min
Jin Hong
JH
Prevots
D Rebecca
DR
Goldfeder
Lisa C
LC
Lee
Hyeyoung
H
Eum
Seok Yong
SY
Jeon
Doo Soo
DS
Kang
Hyung Seok
HS
Kim
Jin Hee
JH
Kim
Byoung Ju
BJ
Kim
Dae Yeon
DY
Holland
Steven M
SM
Park
Seung Kyu
SK
Cho
Sang Nae
SN
Barry
Clifton E
CE
Via
Laura E
LE
D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D015331:Cohort Studies; D054908:Extensively Drug-Resistant Tuberculosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D024841:Fluoroquinolones / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D007723:Korea / Q000453:epidemiology; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D016896:Treatment Outcome
D000995:Antitubercular Agents; D024841:Fluoroquinolones