J Korean Med Sci.  2021 Jul;36(26):e174. 10.3346/jkms.2021.36.e174.

Additional Drug Resistance in Patients with Multidrug-resistant Tuberculosis in Korea: a Multicenter Study from 2010 to 2019

• Lee T
• Lee SJ
• Jeon D
• Lee HY
• Kim HJ
• Kang BH
• Mok J

• KMID: 2518007
• DOI: http://doi.org/10.3346/jkms.2021.36.e174

Abstract

Background
Drug-resistance surveillance (DRS) data provide key information for building an effective treatment regimen in patients with multidrug-resistant tuberculosis (MDR-TB). This study was conducted to investigate the patterns and trends of additional drug resistance in MDR-TB patients in South Korea.
Methods
Phenotypic drug susceptibility test (DST) results of MDR-TB patients collected from seven hospitals in South Korea from 2010 to 2019 were retrospectively analyzed.
Results
In total, 633 patients with MDR-TB were included in the analysis. Of all patients, 361 (57.0%) were new patients. All patients had additional resistance to a median of three antiTB drugs. The resistance rates of any fluoroquinolone (FQ), linezolid, and cycloserine were 26.2%, 0.0%, and 6.3%, respectively. The proportions of new patients and resistance rates of most anti-TB drugs did not decrease during the study period. The number of additional resistant drugs was significantly higher in FQ-resistant MDR-TB than in FQ-susceptible MDR-TB (median of 9.0 vs. 2.0). Among 26 patients with results of minimum inhibitory concentrations for bedaquiline (BDQ) and delamanid (DLM), one (3.8%) and three (11.5%) patients were considered resistant to BDQ and DLM with interim critical concentrations, respectively. Based on the DST results, 72.4% and 24.8% of patients were eligible for the World Health Organization's longer and shorter MDR-TB treatment regimen, respectively.
Conclusion
The proportions of new patients and rates of additional drug resistance in patients with MDR-TB were high and remain stable in South Korea. A nationwide analysis of DRS data is required to provide effective treatment for MDR-TB patients in South Korea.

Keyword

Multidrug-resistant; Resistance; South Korea; Tuberculosis

Figure

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  Fig. 1 Overall distribution of minimum inhibitory concentrations in 26 patients with multidrug-resistant tuberculosis. (A) Bedaquiline. (B) Delamanid.MIC = minimum inhibitory concentration

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  Fig. 2 Annual trends in the proportions of patients eligible for the World Health Organization longer and shorter multidrug-resistant tuberculosis treatment regimens.aPatients susceptible to all fluoroquinolones and cycloserine (assuming all patients are also susceptible to bedaquiline, linezolid, and clofazimine); bPatients fully susceptible to all fluoroquinolones, prothionamide, ethambutol, and pyrazinamide (assuming all patients are also susceptible to bedaquiline and clofazimine).

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