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Treatment Outcomes of Patients with Multidrug-Resistant Tuberculosis: Comparison of Pre- and Post-Public-Private Mix Periods

Tuberculosis and Respiratory Diseases 2021년 84권 1호 p.74 ~ 83
강예원, 조은정, 엄중섭, 김미현, 이광하, 김기욱, 박혜경, 이민기, 목정하,
소속 상세정보
강예원 ( Kang Ye-Won ) - VHS Medical Center Department of Internal Medicine
조은정 ( Jo Eun-Jung ) - Pusan National University Hospital Department of Internal Medicine
엄중섭 ( Eom Jung-Seop ) - Pusan National University Hospital Department of Internal Medicine
김미현 ( Kim Mi-Hyun ) - Pusan National University Hospital Department of Internal Medicine
이광하 ( Lee Kwang-Ha ) - Pusan National University Hospital Department of Internal Medicine
김기욱 ( Kim Ki-Uk ) - Pusan National University Hospital Department of Internal Medicine
박혜경 ( Park Hye-Kyung ) - Pusan National University Hospital Department of Internal Medicine
이민기 ( Lee Min-Ki ) - Pusan National University Hospital Department of Internal Medicine
목정하 ( Mok Jeong-Ha ) - Pusan National University Hospital Department of Internal Medicine

Abstract


Background: This study compared the treatment outcomes of patients with multidrug-resistant tuberculosis (MDR-TB) before and after the implementation of public-private mix (PPM). Factors affecting treatment success were also investigated.

Methods: Data from culture-confirmed pulmonary MDR-TB patients who commenced MDR-TB treatment at Pusan National University Hospital between January 2003 and December 2017 were retrospectively reviewed. Patients were divided into two groups in terms of PPM status: pre-PPM period, patients who commenced MDR-TB treatment between 2003 and 2010; and post-PPM period, patients treated between 2011 and 2017.

Results: A total of 176 patients were included (64 and 112 in the pre- and post-PPM periods, respectively). 36.9% of the patients were resistant to a fluoroquinolone or a second-line injectable drug, or both. The overall treatment success rate was 72.7%. The success rate of post-PPM patients was higher than that of pre-PPM patients (79.5% vs. 60.9%, p=0.008). Also, loss to follow-up was lower in the post-PPM period (5.4% vs. 15.6%, p=0.023). In multivariate regression analysis, age ≥65 years, body mass index ≤18.5 kg/m2, previous TB treatment, bilateral lung involvement, and extensively drug-resistant (XDR)- or pre-XDR-TB were associated with poorer treatment outcomes. However, the use of bedaquiline or delamanid for ≥1 month increased the treatment success.

Conclusion: The treatment success rate in MDR-TB patients was higher in the post-PPM period than in the pre-PPM period, particularly because of the low rate of loss to follow-up. To ensure comprehensive patient-centered PPM in South Korea, investment and other support must be adequate.

키워드

Multidrug-Resistant Tuberculosis; PPM; Public-Private Mix; South Korea; Treatment Outcome

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