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논문 상세정보

일개 결핵병원에서 다제내성결핵과 광범위내성결핵의 추이, 2001~2005

Trend of Multidrug and Extensively Drug Resistant Tuberculosis in a Tuberculosis Referral Hospital, 2001~2005

초록

연구배경: 다제내성결핵과 광범위내성결핵은 전세계적으로 결핵 치료에 큰 위협으로 등장하고 있지만 이에 대한 국내의 정확한 실태 및 추이는 잘 알려져 있지 않다. 일개 결핵병원에서 다제내성결핵과 광범위내성결핵의 빈도 및 추이를 살펴봄으로써 국내 실태를 간접적으로 파악하고자 하였다. 방법: 2001년부터 2005년 사이에 국립마산병원에 입원하여 배양양성 결핵으로 진단된 환자를 대상으로 약제 감수성검사 결과와 의무기록을 후향적으로 분석하였다. 결과: 2001년부터 2005년 사이에, 다제내성결핵은 신환자에서 9.2%, 13.8%, 16.9%, 23%, 27.0%로 의미있게 증가하였고(p<0.001 for trend) 재치료환자에서 9.1%, 15.7%, 17.3%, 19.9%, 19.1%로 의미있게 증가하였다 (p=0.002 for trend). 광범위내성결핵은 신환자에서 0%, 2.3%, 3.1%, 2.5%, 6.3%로 의미있게 증가하였고(p=0.005 for trend) 재치료환자에서 9.1%, 15.7%, 17.3%, 19.9%, 19.1%로 의미있게 증가하였다(p<0.001 for trend). 결론: 다제내성결핵과 광범위내성결핵은 신환자와 재치료환자 모두에서 증가하는 추이를 보였다. 국내의 정확한 실태 파악을 위하여 공공 및 민간의료기관을 포괄하는 통합적인 약제내성실태 조사가 필요할 것으로 사료된다.

Abstract

Background: Multidrug-resistant tuberculosis (MDR-TB) and extensively drug resistant tuberculosis (XDR-TB) are serious threats to worldwide tuberculosis control, but the national burden and the trends of infectious spread are largely unknown. Methods: We retrospectively reviewed the results of drug sensitivity tests and medical records of patients that were diagnosed with culture-confirmed pulmonary tuberculosis and were admitted to the National Masan Tuberculosis Hospital between 2001 and 2005. Results: From 2001 to 2005, the proportion of MDR-TB among new cases was 9.2%, 13.8%, 16.9%, 23% and 27.0% in 2001, 2002, 2003, 2004 and 2005, respectively, and the proportion of MDR-TB among previously treated cases was 58.5%, 60.2%, 62.7%, 61.7% and 71.3% in 2001, 2002, 2003, 2004 and 2005, respectively. A significant increasing trend could be discerned for MDR-TB among both new and previously treated cases (p<0.001, p=0.002 for trend, respectively). The proportion of XDR-TB among new cases was 0%, 2.3%, 3.1%, 2.5% and 6.3% in 2001, 2002, 2003, 2004 and 2005, respectively, and the proportion of XDR-TB among previously treated cases was 9.1%, 15.7%, 17.3%, 19.9% and 19.1% in 2001, 2002, 2003, 2004 and 2005, respectively. A significant increasing trend could be discerned for XDR-TB among both new and previously treated cases (p=0.005, p<0.001 for trend, respectively). Conclusion: Both MDR-B and XDR-TB were gradually increased among both new and previously treated cases. Integrated national surveillance, including the public and private sectors, will be needed to estimate the exact status of antituberculous drug resistance.

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