결핵균의 항결핵제 내성 전환 패턴
The Patterns of Conversion to Anti-Tuberculosis Drug Resistance in Mycobacterium tuberculosis
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
다제내성결핵과 광범위내성결핵은 결핵 치료의 문제가 되고 있으며 발생빈도 역시 증가하고 있다. 본 연구는 2010년 1월부터 2019년 12월까지 녹십자의료재단 의뢰된 환자를 대상으로 Löwenstein-Jensen 고체배지와 pyrazinamide for pyrazinamidase를이용하여 약물감수성시험(DST)을 시행하여 내성으로 전환되는 항결핵제 패턴과 평균 추적 기간을 분석하였다. 항결핵제 중 1개 이상의 항결핵제 내성을 보인 증례들에서 초기 의뢰 시 INH 항결핵제에 내성인 경우가 55명(33.1%)으로 가장 높은 비율로 나타났으며, 내성으로 전환된 항결핵제는 EMB 17명(26.6%), RFP 14명(21.9%), QUI 14명(21.9%), PZA 12명(10.9%) 순으로 조사되었다. 10개의 항결핵제에 모두 감수성인 증례들에서는 INH 항결핵제에 대한 내성 전환은 43명(7.2%)으로 가장 빈도가 높았으며, 평균 추적 기간은435.6일로 조사되었으며, 내성으로 전환되는 항결핵제의 내성전환율은 INH 43명(7.2%), RFP 23명(3.9%), SM 11명(1.9%), QUI 4명(0.7%), AMK 3명(0.5%), EMB 3명(0.5%)이었다. 이에 본 연구는 항결핵제에 대한 감수성에서 내성으로의 전환은 특히 다제내성결핵과 광범위내성결핵의 전환되는 환자에게 매우 중요한 자료가 될 것으로 보이며, 결핵 치료에서 환자 치료에 도움이 될 것으로 사료된다.
Abstract
The prevalence of multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) are increasing. We analyzed the patterns of drug resistance and tracking period days of acquiring anti-mycobacterial resistance. From January 2010 to December 2019, drug susceptibility tests (DST) were performed by the absolute concentration method using the Löwenstein-Jensen solid medium and pyrazinamidase activity test (to assess pyrazinamide resistance) in samples from patients who were referred to the Green Cross Laboratories in Yongin. Among the cases that showed resistance to one or more anti-tuberculosis drugs, 55 patients (33.1%) were resistant to isoniazid (INH) at the time of initial referral, and the rates for the development of resistant anti-tuberculosis drugs were ethambutol (EMB) (26.6%), rifampicin (RFP) (21.9%), quinolones (QUI) (21.9%) and pyrazinamide (PZA) (10.9%), in that order. In the cases sensitive to all 10 anti-tuberculosis drugs initially, the development of resistance to INH was the most frequent, seen in 43 patients (7.2%). The average follow-up period was 435.6 days, and the resistance development was observed in the order of INH (7.2%), RFP (3.9%), SM (1.9%), QUI (0.7%), amikacin (AMK) (0.5%), and EMB (0.5%). The conversion of susceptible strains to resistant strains is an important warning sign for the patient, especially in cases of conversion to MDR or XDR. This information would be helpful for improving patient care during TB treatment.
참고문헌 (18)
- GBD Tuberculosis Collaborators, "The global burden of tuberculosis : results from the Global Burden of Disease Study 2015", Lancet Infect Dis, 18, pp.261~284 (2018)[DOI]
- Annual report on the notified tuberculosis patients in Korea 2019, "Korea Centers for Disease Control and Prevention", Korea Centers for Disease Control and Prevention, 35~41 (2020)
- Korea Centers for Disease Control and Prevention, "Korean guidelines for tuberculosis", pp.16~59 (2020), Korea Centers for Disease Control and Prevention
- Pablos-Mendez A, "Global surveillance for antituberculosis-drug resistance, 1994-1997. World Health Organization-International Union against tuberculosis and lung disease working group on anti-tuberculosis drug resistance surveillance", N Engl J Med, 338, pp.1641~1649 (1998)[DOI]
- Centers for Disease Control and Prevention (CDC), "Emergence of Mycobacterium tuberculosis with extensive resistance to second-line drugs--worldwide, 2000-2004", MMWR Morb Mortal Wkly Rep, 55, pp.301~305 (2006)[DOI]
- Velayati AA, "Emergence of new forms of totally drug-resistant tuberculosis bacilli : super extensively drug-resistant tuberculosis or totally drug-resistant strains in iran", Chest, 136, pp.420~425 (2009)[DOI]
- Espinal MA, "Global trends in resistance to antituberculosis drugs. World Health Organization-International union against tuberculosis and lung disease working group on anti-tuberculosis drug resistance surveillance", N Engl J Med, 344, pp.1294~1303 (2001)[DOI]
- Mitchison DA, "Drug resistance in tuberculosis", Eur Respir J, 25, pp.376~379 (2005)[DOI]
- WHO treatment guidelines for drugresistant tuberculosis, "World Health Organization", World Health Organization, ~ (2016)
- Kyutaeg Lee, "항결핵제 감수성 결핵에서의 내성 변화 추이", 대한임상검사과학회지, 53(2), pp.137~142 (2021), 대한임상검사과학회[DOI]
- 손은정, "한국의 결핵 현황 및 국가결핵관리사업", 대한의사협회지, 64(4), pp.316~323 (2021), 대한의사협회
- Kim DH, "Treatment outcomes and long-term survival in patients with extensively drug-resistant tuberculosis", Am J Respir Crit Care Med, 178, pp.1075~1082 (2008)[DOI]
- Guidelines for the programmatic management of drug-resistant tuberulosis. Emergency update 2008, "World Health Organizaton", World Health Organization, ~ (2008)
- Joint Committee for the Development of Korean Guideline for Tuberculosis, "Korean guidelines for tuberculosis" (2011), Korea Centers for Disease Control and Prevention
- 강영애, "다제내성 결핵의 진단과 치료", 대한의사협회지, 57(1), pp.27~33 (2014), 대한의사협회[DOI]
- Van Deun A, "Short, highly effective, and inexpensive standardized treatment of multidrug-resistant tuberculosis", Am J Respir Crit Care Med, 182, pp.684~692 (2010)[DOI]
- 김병주, "국내 다제내성 결핵의 실태", Tuberculosis and Respiratory Diseases, 60(4), pp.404~411 (2006), 대한결핵및호흡기학회
- Global tuberculosis report 2018, "World Health Organization", World Health Organization, ~ (2018)