Abstract
BackgroundThe emergence of drug-resistant tuberculosis (DR-TB) is a major healthcare concern worldwide. Here, we analyzed age-related trends in DR-TB rates in South Korea.MethodsDrug susceptibility test results were collected from patients with culture-confirmed TB between 2015 and 2018 from eight university-affiliated hospitals. Patients were divided into three subgroups: younger (15–34 years), middle (35–59 years), and older (≥60 years) to compare drug-resistance patterns. To evaluate trends in age-stratified drug-resistance, chi-square test for linear trends was performed.ResultsAmong enrolled native patients aged ≥15 years, 4.1% (179/4417), 1.2% (53/4417) and 7.2% (316/4417) were multidrug-resistant TB (MDR-TB), rifampicin-mono-resistant TB (RR-TB), and isoniazid-mono-resistant TB (Hr-TB), respectively. Proportions of Hr-TB cases were 5.4% (40/734), 7.2% (114/1593), and 7.8% (162/2090) in the younger, middle and older age groups, respectively. MDR/RR-TB case rates decreased significantly with age from 8.6% (63/734) in younger age group to 3.3% (68/2090) in older age group. Fluoroquinolone resistance was highest among second-line drugs, and there were no differences in resistance to fluoroquinolones and second-line injectable drugs among the three age groups.ConclusionsThe number of MDR/RR-TB cases was highest in young patients. Effective public health interventions should include increased focus on rifampicin resistance in young patients.
Highlights
The emergence of drug-resistant tuberculosis (DR-TB) is a major healthcare concern worldwide
Anti-TB drug resistance rates declined after improved treatment efficiency in South Korea in the 1980s, nationwide drug surveillance conducted between 1994 and 2004 revealed that drug resistance had increased among new TB cases [4]
Considering South Korea’s unique history of improved socioeconomic status and decreased TB incidence observed over a half century, we hypothesized that age and generation might represent multifactorial causes of emergence of drugresistance, such as inappropriate regimens, use of lowerthan-recommended doses, poor drug quality and poor treatment adherence [8], and the degree and status of TB exposure in the younger generation differ from that in the previous generation, which may affect drug resistance profiles
Summary
The emergence of drug-resistant tuberculosis (DR-TB) is a major healthcare concern worldwide. A 95% reduction in TB mortality and 90% reduction in its incidence compared to that in 2015 should be achieved by 2035 according to anti-TB drug resistance rates declined after improved treatment efficiency in South Korea in the 1980s, nationwide drug surveillance conducted between 1994 and 2004 revealed that drug resistance had increased among new TB cases [4]. Considering South Korea’s unique history of improved socioeconomic status and decreased TB incidence observed over a half century, we hypothesized that age and generation might represent multifactorial causes of emergence of drugresistance, such as inappropriate regimens, use of lowerthan-recommended doses, poor drug quality and poor treatment adherence [8], and the degree and status of TB exposure in the younger generation differ from that in the previous generation, which may affect drug resistance profiles.
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