호흡기 검체에서 분리된 결핵균의 항결핵제 내성 실태: 국내 다기관 연구
Anti-Tuberculosis Drug Resistant Rates in Mycobacterium tuberculosis Isolated from Respiratory Specimens: A Multicenter Study in Korea
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배경: 호흡기 검체에서 검출된 모든 결핵균을 대상으로 초치료와 재치료 환자군으로 나누어 총 15종의 항결핵제 내성률을 조사하였다. 방법: 2010년 2월에서 7월 사이에 전국에 분포한 국내 6개 대학병원의 호흡기 검체에서 검출된 모든 결핵균을 대상으로하였다. 과거 치료력에 따라 초치료군과 재치료군으로 나누어 항결핵제 내성률을 조사하고 지역별로 내성양상을 비교해보았다. 결과: 총 542명의 환자 중 초치료군이 473명(87.3%), 재치료군이 69명(12.7%)이었다. 초치료군과 재치료군 간에 다제내성결핵, fluoroquinolone 계(ofloxacin, levofloxacin, and moxifloxacin) 내성률 및 광범위내성결핵 비율은 초치료군에서는 각각3.8%, 1.1-1.5% 및 0%였고 재치료군에서는 각각 21.7%, 13.0-17.4% 및 4.3%였다. 재치료군에서 분리된 다제내성결핵 중20% (3/15)가 광범위내성결핵이었다. 항결핵제 내성률은 지역적 분포에 따라 다양하였다. 결론: 다제내성결핵 및 광범위내성결핵의 빈도가 재치료군에서 크게 높아지므로 결핵 환자의 초회 치료가 성공할 수있도록 관리하는 것이 필요할 것으로 생각한다. 더불어, 재치료군에서는 항결핵제를 선택하기 전에, fluoroquinolone을포함한 항결핵제 감수성 검사의 결과확인이 필수적이다.
Abstract
Background: We analyzed the prevalence of anti-tuberculosis drug resistance in Mycobacterium tuberculosis isolates from respiratory specimens of patients with newly diagnosed and previously treated tuberculosis. Methods: From February 2010 to July 2010, a total of 542 M. tuberculosis clinical isolates were collected from pulmonary tuberculosis patients in six university hospitals distributed throughout Korea. We analyzed the results of anti-tuberculosis drug resistance tests according to treatment history and geographic location. Results: Among the 542 isolates, 473 (87.3%) were from newly diagnosed cases and 69 (12.7%) were from previously treated cases. The rates of multi-drug resistance (MDR), fluoroquinolone (ofloxacin, levofloxacin, and moxifloxacin) resistance, and extensive drug resistance (XDR) were 3.8%, 1.1-1.5%, and 0%, respectively, in new cases, and 21.7%, 13.0-17.4%, and 4.3%, respectively, in previously treated cases. In the previously treated cases, the proportions of XDR-TB in MDR-TB were 20% (3/15). The resistance rates were variable according to geographic location. Conclusion: As the anti-tuberculosis drug resistance rates are much higher in newly diagnosed cases than in previously treated patients, efforts should be made to ensure that tuberculosis treatment is successful. In addition, before the selection of an anti-tuberculosis drug treatment for previously treated patients, the susceptibility test results, including to fluoroquinolone, should be verified.
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