항결핵제 감수성 결핵에서의 내성 변화 추이
The Patterns of Acquiring Anti-Mycobacterial Drug Resistance by Susceptible Strains of Mycobacterium tuberculosis
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초록
본 연구는 결핵환자의 초기 치료에서 모든 항결핵제에 감수성을 보이는 경우, 치료 과정 중 항결핵제에 대한 내성 전환을 조사하였다. 2010년 1월부터 2019년 12월까지 111개 의료기관에서 녹십자의료재단에 항결핵제감수성 검사를 의뢰한 760건의 환자를 대상으로 하였다. 항결핵제에 모두 감수성인 594명중 추적 기간에 감수성에서 내성으로 전환되는 56명을 분석한결과 INH, RIF, SM, QUI 순으로 단독 내성 전환율이 가장 높게나타났으며, INH, RIF에 동시에 복합 내성을 보인 경우는 56명중 17명(30.4%)으로 높은 내성 전환율을 보이고 있다. 전환 시기는 INH 항결핵제는 최소 98일부터 1,862일, 평균 435.6일이며, RIF 항결핵제는 최소 108일부터 1,673일, 평균 457.7일로 분석되었다. 이에 본 연구는 결핵 초기 치료 후 모든 항결핵제에 감수성을 보였다면 3개월이 지난 시점에서 반드시 항결핵제감수성 검사를 통해 내성 전환 및 다제내성결핵을 확인해야만한다고 사료되며, 국민보건향상과 국민건겅증진을 위한 국가결핵관리 사업에 도움이 되었으면 한다.
Abstract
This study investigated the patterns of acquiring anti-mycobacterial resistance in individuals who were susceptible to all anti-mycobacterial drugs in their initial treatment. From 2010 to 2019, anti-mycobacterial drug susceptibility tests were conducted on patients who were referred to the Green Cross Laboratories. The test results of 594 anti-mycobacterial drug sensitivity tests were collected at 111 medical institutions. The first test results had 594 cases in which all anti-mycobacterial drugs were susceptible. Isoniazid (INH), rifampin (RIF), streptomycin (SM), and quinolone (QUI) showed the highest single-resistant conversion rates. Out of 56 patients, 17 patients (30.4%) showed a high conversion rate of resistance to both INH and RIF. The tracking period was analyzed from a minimum of 98 days to 1,862 days, and an average of 435.6 days for INH, and a minimum of 108 days to 1,673 days, with an average of 457.7 days for RIF. In the case of tuberculosis patients who are susceptible to all anti-mycobacterial drugs, it is considered that the conversion to resistant and multi-drug resistant tuberculosis (MDR-TB) must be confirmed through an anti-mycobacterial susceptibility test after 3 months. It is hoped that this study will help the national tuberculosis management project to improve public health.
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