Tuberc Respir Dis.  2006 Feb;60(2):194-204.

The Clinical Characteristics, Diagnosis, Treatment, and Outcomes of Patients with Tuberculosis at a Private University Hospital in Korea

• Jung YJ
• Park IN
• Hong SB
• Oh YM
• Lim CM
• Lee SD
• Koh Y
• Kim WS
• Kim DS
• Kim WD
• Shim TS

Abstract

BACKGROUND: Even though tuberculosis (TB) is still a major public concern in Korea, there is little data on the management of TB patients and its outcomes in the private sector. This study evaluated the status of TB treatment in the private sector.
METHODS
Sixteen-hundred-sixty-six TB patients who were notified in a private university hospital from 2001 to 2002 were enrolled in this study. The patients were divided into pulmonary (TB(P)), extrapulmonary (TB(E)), and combined (TB(P+E)) groups, and were also divided into initial and retreatment groups. The clinical characteristics, diagnostic methods, treatment regimens, and outcomes were analyzed and compared.
RESULTS
The mean age of the 1,666 patients was 48.9 years and the male-to-female ratio was 1.3:1. The number of patients in the initial and retreatment groups of TB(P), and those of (TB(E) + TB(P+E)) were 809, 276, 480, 101, respectively. A bacteriological study was performed in 92.0% of cases, and a positive culture was confirmed in 58.1% and 31.7% of patients with TB(P) and (TB(E) + TB(P+E)), respectively (p<0.05). The AFB smear was positive in 45.4% of the TBP patients. PCR was carried out in 60.4% of the (TB(E) + TB(P+E)) group. The MDR was detected in 14.0% of isolates. Overall, the treatment completion, default, and death rates were 70.2%, 13.5% and 1.9%, respectively.
CONCLUSION
Even though the management of TB patients in a private hospital was satisfactory in terms of the national guidelines, the high default rate was is still a problem. Efforts to decrease the default rate either independently or in cooperation with the public sector will be needed.

Keyword

Tuberculosis; Private Sector; Korea; Diagnosis; Treatment; Treatment outcome

MeSH Terms

Diagnosis*
Hospitals, Private
Humans
Korea*
Mortality
Polymerase Chain Reaction
Private Sector
Public Sector
Retreatment
Treatment Outcome
Tuberculosis*

Reference

1. Ministry of Health and Welfare KNTA. Report on the 7th tuberculosis prevalence survey in Korea. 1996. Seoul: Ministry of Health and Welfare, Korean National Tuberculosis Association.

2. Lew WJ. Tuberculosis surveillance system in Korea. Tuberc Respir Dis. 2000. 48:298–307.

3. Lee EK. Situation of incidence of tuberculosis in Korea. Communica Dis Month Rep. 2003. 14:359–367.

4. Bai GH. Anti-tuberculosis drug resistance in Korea. Communica Dis Month Rep. 2005. 16:101–107.

5. Korea National Statistical Office. Annual statistics of causes of mortality 2004. 2005. Seoul: Korea National Statistical Office.

6. Korea Center for Disease Control and Prevention. Korean Institute of Tuberculosis. Annual report on the notified tuberculosis patients in Korea. 2005. Seoul: Korea Center for Disease Control and Prevention, Korean Institute of Tuberculosis.

7. Koh WJ, Kwon OJ, Kim CH, Ahn YM, Lim SY, Yun JW, et al. Clinical characteristics and treatment outcomes of patients with pulmonary tuberclosis at a private general hospital. Tuberc Respir Dis. 2003. 55:154–164.

8. Park KD. Tuberculosis management of private health care institution: current situation and task. Tuberc Respir Dis. 2002. 52:579–589.

9. Jin BW, Jang DJ. An analysis of tuberculosis management in private sector. Tuberc Respir Dis. 1990. 37:399–406.

10. Hong YP, Kim SJ, Lee EG, Lew WJ, Bai JY. Treatment of bacillary pulmonary tuberculosis at the chest clinics in the private sector in Korea, 1993. Int J Tuberc Lung Dis. 1999. 3:695–702.

11. American Thoracic Society / Center for Disease Control and Prevention. Center for Disease Control and Prevention. Diagnostic standards and classification of tuberculosis in adults and children. Am J Respir Crit Care Med. 2000. 161:1376–1395.

12. World Health Organization. Treatment of tuberculosis: guidelines for national programmes. 2003. 3rd ed. Geneva, Switzerland: WHO.

13. Korean Academy of Tuberculosis and Respiratory Diseases. Guideline for the management of pulmonary tuberculosis, 1997. Tuberc Respir Dis. 1997. 44:1447–1453.

14. Kim CH, Koh WJ, Kwon OJ, Ahn YM, Lim SY, An CH, et al. The accuracy of tuberculosis notification reports at a private general hospital after enforcement of new Korean Tuberculosis Surveillance System. Tuberc respir Dis. 2003. 54:178–190.

15. Hong YP, Kim SJ, Kwon DW, Chang SC, Lew WJ, Han YC. The sixth Nationwide Tuberculosis Prevalence Survey in Korea, 1990. Tuber Lung Dis. 1993. 74:323–331.

16. Hong YP, Kwon DW, Kim SJ, Chang SC, Kang MK, Lee EP, et al. Survey of knowledge, attitudes and practices for tuberculosis among general practitioners. Tuber Lung Dis. 1995. 76:431–435.

17. National Institution of Health. Guideline of the control of tuberculosis. 2003. Seoul: National Institution of Health.

18. Korean Academy of Tuberculosis and Respiratory Diseases. Guideline for the management of tuberculosis. 2005. Seoul: Korean Academy of Tuberculosis and Respiratory Diseases.

19. Bass JB Jr, Farer LS, Hopewell PC, O'Brien R, Jacobs RF, Ruben F, et al. Treatment of tuberculosis and tuberculosis infection in adults and children. Am J Respir Crit CareMed. 1994. 149:1359–1374.

20. Blumberg HM, Burman WJ, Chaisson RE, Daley CL, Etkind SC, Friedman LN, et al. American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis. Am J Respir Crit Care Med. 2003. 167:603–662.

21. Lew WJ, Kim SJ, Kim HJ, Lee EG, Kang MK, Bai JK. The treatment outcomes of 'defaulted' or 'transferred out' tuberculosis patients in Korea. Tuberculosis Surveillance Research Unit Pregress Report. 2001. 137–150.

22. Hong YP, Kim SJ, Lew WJ, Lee SH, Lee EK. Cohort analyses of the treatment of smear-positive pulmonary tuberculosis patients under programme conditions in Korea, 1983-1994. Int J Tuberc Lung Dis. 1998. 2:365–371.

23. Yum HK, Song YS, Jeon SY, Choi SJ, Lee BC, Kim DS. The incidence of drug resistant tuberculosis in 1279 Korean patients. Korean J Intern Med. 1995. 10:38–42.

24. Lee JH, Chang JH. Drug-resistant tuberculosis in a tertiary referral teaching hospital of Korea. Korean J Intern Med. 2001. 16:173–179.

25. Kim SY, Jeong SS, Kim KW, Shin KS, Park SG, Kim AK, et al. Drug-resistant pulmonary tuberculosis in a tertiary referral hospital in Korea. Korean J Intern Med. 1999. 14:27–31.

26. Yum HK, Choi SJ, Lee BC, Kim DS. Treatment results of multidrug resistant tuberculosis in a university hospital in Korea. Tuberc Respir Dis. 1996. 43:862–868.

27. Park SK, Kim CT, Song SD. Outcome of chemotherapy in 107 patients with pulmonary tuberculosis resistant to isoniazid and rifampin. Int J Tuberc Lung Dis. 1998. 2:877–884.

28. Park SK, Lee WC, Lee DH, Mitnick CD, Han L, Seung KJ. Self-administered, standardized regimens for multidrug-resistant tuberculosis in South Korea. Int J Tuberc Lung Dis. 2004. 8:361–368.

29. Kim HJ, Hong YP, Kim SJ, Lew WJ, Lee EG. Ambulatory treatment of multidrug-resistant pulmonary tuberculosis patients at a chest clinic. Int J Tuberc Lung Dis. 2001. 5:1129–1136.

30. Chan ED, Laurel V, Strand MJ, Chan JF, Huynh ML, Goble M, et al. Treatment and outcome analysis of 205 patients with multidrug-resistant tuberculosis. Am J Respir Crit Care Med. 2004. 169:1103–1109.