Nationwide Treatment Outcomes of Patients With Multidrug/Rifampin-Resistant Tuberculosis in Korea, 2011–2017: A Retrospective Cohort Study (Korean TB-POST)

Background The treatment outcomes of patients with multidrug/rifampin-resistant (MDR/RR) tuberculosis (TB) are important indicators that reflect the current status of TB management and identify the key challenges encountered by TB control programs in a country. Methods We retrospectively evaluated the treatment outcomes as well as predictors of unfavorable outcomes in patients with MDR/RR-TB notified from 2011 to 2017, using an integrated TB database. Results A total of 7,226 patients with MDR/RR-TB were included. The treatment success rate had significantly increased from 63.9% in 2011 to 75.1% in 2017 (P < 0.001). Among unfavorable outcomes, the proportion of patients who failed, were lost to follow up, and were not evaluated had gradually decreased (P < 0.001). In contrast, TB-related death rate was not significantly changed (P = 0.513), while the non-TB related death rate had increased from 3.2% in 2011 to 11.1% in 2017 (P < 0.001). Older age, male sex, immigrants, low household income, previous history of TB treatment, and comorbidities were independent predictors of unfavorable outcomes. Of the 5,308 patients who were successfully treated, recurrence occurred in 241 patients (4.5%) at a median 18.4 months (interquartile range, 9.2–32.4) after completion treatment. Conclusion The treatment outcomes of patients with MDR/RR-TB has gradually improved but increasing deaths during treatment is an emerging challenge for MDR-TB control in Korea. Targeted and comprehensive care is needed for vulnerable patients such as the elderly, patients with comorbidities, and those with low household incomes.

[1]  J. Myong,et al.  Latent Tuberculosis Cascade of Care Among Healthcare Workers: A Nationwide Cohort Analysis in Korea Between 2017 and 2018 , 2022, Journal of Korean medical science.

[2]  G. Maartens,et al.  Treatment outcomes 24 months after initiating short, all-oral bedaquiline-containing or injectable-containing rifampicin-resistant tuberculosis treatment regimens in South Africa: a retrospective cohort study , 2022, The Lancet. Infectious diseases.

[3]  Jinsun Kim,et al.  Cohort Profile: Korean Tuberculosis and Post-Tuberculosis Cohort Constructed by Linking the Korean National Tuberculosis Surveillance System and National Health Information Database , 2022, Journal of preventive medicine and public health = Yebang Uihakhoe chi.

[4]  A. McLaughlin,et al.  New developments in tuberculosis diagnosis and treatment , 2022, Breathe.

[5]  S. Rhee,et al.  Diabetes Status and Association With Risk of Tuberculosis Among Korean Adults , 2021, JAMA network open.

[6]  Chaemin Chun,et al.  Latent Tuberculosis Infection Screening and Treatment in Congregate Settings (TB FREE COREA): Demographic Profiles of Interferon-Gamma Release Assay Cohort , 2021, Journal of Korean medical science.

[7]  D. Jeon,et al.  Current situation of tuberculosis and National Strategic Plan for Tuberculosis Control in Korea , 2021 .

[8]  J. Yim,et al.  Outcomes of multidrug-resistant tuberculosis treated with bedaquiline or delamanid. , 2021, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[9]  Mi-Hyun Kim,et al.  Treatment Outcomes of Patients with Multidrug-Resistant Tuberculosis: Comparison of Pre- and Post-Public–Private Mix Periods , 2020, Tuberculosis and respiratory diseases.

[10]  H. Koo,et al.  Impact of COVID-19 Pandemic on the National PPM Tuberculosis Control Project in Korea: the Korean PPM Monitoring Database between July 2019 and June 2020 , 2020, Journal of Korean medical science.

[11]  J. Yim,et al.  Impact of Molecular Drug Susceptibility Testing on the Time to Multidrug-resistant Tuberculosis Treatment Initiation , 2020, Journal of Korean medical science.

[12]  Jae Seuk Park,et al.  Tuberculosis Surveillance and Monitoring under the National Public-Private Mix Tuberculosis Control Project in South Korea 2016–2017 , 2020, Tuberculosis and respiratory diseases.

[13]  K. Dooley,et al.  The Lancet Respiratory Medicine Commission: 2019 update: epidemiology, pathogenesis, transmission, diagnosis, and management of multidrug-resistant and incurable tuberculosis. , 2019, The Lancet. Respiratory medicine.

[14]  J. Yim,et al.  Multidrug-resistant tuberculosis in South Korea: a retrospective analysis of national registry data in 2011-2015. , 2019, The International Journal of Tuberculosis and Lung Disease.

[15]  Joon Chang,et al.  Improved Fluoroquinolone-Resistant and Extensively Drug-Resistant Tuberculosis Treatment Outcomes , 2019, Open forum infectious diseases.

[16]  J. Yim,et al.  Multidrug-resistant tuberculosis over 20 years at a referral hospital in South Korea: trends and outcomes. , 2019, The International Journal of Tuberculosis and Lung Disease.

[17]  G. Maartens,et al.  Effect of bedaquiline on mortality in South African patients with drug-resistant tuberculosis: a retrospective cohort study. , 2018, The Lancet. Respiratory medicine.

[18]  T. Holtz,et al.  Treatment correlates of successful outcomes in pulmonary multidrug-resistant tuberculosis: an individual patient data meta-analysis , 2018, The Lancet.

[19]  R. Duarte,et al.  Tuberculosis, social determinants and co-morbidities (including HIV). , 2017, Pulmonology.

[20]  H. Yoo,et al.  Tuberculosis Notification Completeness and Timeliness in the Republic of Korea During 2012–2014 , 2016, Osong public health and research perspectives.

[21]  M. Noursadeghi,et al.  Does tuberculosis threaten our ageing populations? , 2016, BMC Infectious Diseases.

[22]  J. Yim,et al.  Choice between Levofloxacin and Moxifloxacin and Multidrug-Resistant Tuberculosis Treatment Outcomes. , 2016, Annals of the American Thoracic Society.

[23]  S. Abimbola,et al.  Tuberculosis among older adults--time to take notice. , 2015, International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases.

[24]  K. Floyd,et al.  Beyond UHC: Monitoring Health and Social Protection Coverage in the Context of Tuberculosis Care and Prevention , 2014, PLoS medicine.

[25]  H. Kim,et al.  Diagnostic Accuracy of Notified Cases as Pulmonary Tuberculosis in Private Sectors of Korea , 2012, Journal of Korean medical science.

[26]  M. Uplekar,et al.  Tuberculosis and noncommunicable diseases: neglected links and missed opportunities , 2010, European Respiratory Journal.

[27]  T. Shim,et al.  Treatment outcomes and long-term survival in patients with extensively drug-resistant tuberculosis. , 2008, American journal of respiratory and critical care medicine.