Analysis of discrepant results between phenotypic and genotypic drug susceptibility tests of Mycobacterium tuberculosis isolates at tertiary teaching hospitals: a preliminary result

민진수,정재욱,임진숙,박종혁,신경섭,정성수,이기만 대한결핵 및 호흡기학회 2017 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.124 No.0

Background: South Korea is an intermediate tuberculosis (TB) burden country with high rates of anti-TB drug resistance. We identified patterns of anti-TB drug resistance in Mycobacterium tuberculosis (MTB) isolates and evaluated results of phenotypic and genotypic drug susceptibility tests (DST). Methods: One hundred forty four patients with pulmonary TB were recruited into a prospective observational cohort study at two hospitals from December 2016 to June 2017. We determined the drug susceptibility of MTB isolates by using conventional phenotypic DST and GenoType MTBDRplus assay. Results: Among 92 patients with culture-positive pulmonary TB, 14 (15.2%) patients with drug-resistant TB were identified on the phenotypic DST; 11 had any isoniazid (INH) resistance, 1 had rifampicin (RFP) monoresistance, 1 had streptomycin monoresistance, and 1 had multidrug-resistance. Two patients had INH resistance on the MTBDRplus assay, but no drug resistance on the phenotypic DST. The sensitivity and specificity of the MTBDRplus assay were respectively 72.7% and 96.7% for the detection of INH resistance; 100.0% and 98.6% for the detection of RFP resistance. Among 72 patients who had both phenotypic and genotypic DSTs, discordant results were found in 5 (6.9%) patients with INH resistance and 1 (1.4%) patient with RFP resistance. Conclusions: The specificity of the MTBDRplus assay in detecting INH and RIF resistance was high. Because of frequent discordant results of INH resistance between phenotypic and genotypic DSTs, physician needs to be careful in interpreting their results.

Nationwide trends in incidence of tuberculosis among people with disabilities in South Korea: a nationwide serial cross-sectional study

민진수,SO-YOUNG KIM,박종은,Yeon-Yong Kim,Jong-Hyock Park 한국역학회 2022 Epidemiology and Health Vol.44 No.-

OBJECTIVES: Studies on the association between disability and tuberculosis (TB) are scarce. We aimed to assess the risk of active TB disease among people with disabilities. METHODS: We conducted a nationwide serial cross-sectional study using national registry linkage databases from 2008 to 2017. The crude and age, sex-standardized incidence rates of TB were analyzed for each year according to the presence, type, and severity of disabilities. The crude incidence rate and odds of developing TB disease were examined by a multivariable logistic regression model using data in 2017. RESULTS: The overall incidence of active TB decreased between 2008 and 2017. Age, sex-standardized incidence rates of TB disease among people with disabilities were significantly higher than among those without disabilities throughout all observed years (P< 0.001). As of 2017, the population with disabilities had a higher crude incidence rate of active TB disease than that without disability (119.9/100,000 vs. 48.5/100,000 person-years, P< 0.001), regardless of sex, income level, and place of residence. Compared to those without disability, those with disabilities had higher odds of active TB (adjusted odds ratio [aOR], 1.19; 95% confidence interval [CI], 1.15-1.24). Mental disability (aOR, 1.51; 95% CI, 1.24-1.84) had the highest odds of active TB incidence, followed by developmental disability (aOR, 1.30; 95% CI, 1.09-1.55). CONCLUSIONS: People with disabilities are at a greater risk of developing TB disease. Active screening and care for TB cases would be beneficial for people with disabilities.

International Medical Mission Facing Global Increase of Chronic Disease: 2-Year Experience in Bangladesh

민진수 대한의학회 2016 Journal of Korean medical science Vol.31 No.2

Specialists of developing countries are facing the epidemic growth of noncommunicable diseases (NCDs). From 2011 to 2013, I, as a Korean volunteer doctor, had been working in a local primary healthcare center in Bangladesh, assessing rates of NCDs. Proportion of patients with NCDs was increased from 74.96% in 1999 to 83.05% in 2012, particularly due to the spreading of diabetes mellitus, cardiovascular diseases, and tuberculosis. To succeed in medical mission in developing countries, volunteer doctors have to take measures for preventing chronic diseases along with proper treatment.

MDR 결핵 치료의 모든 것

민진수 대한내과학회 2023 대한내과학회 추계학술대회 Vol.2023 No.1

PPM 의료기관을 방문한 결핵 사망 환자 분석

민진수,박재석,김주상,신아영,이성순,고운영,박미선,이주선,천가영 대한결핵 및 호흡기학회 2018 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.126 No.-

Background: Although overall incidence of tuberculosis (TB) has decreased in South Korea, it has still high mortality rate. TB mortality is one of the important indicators for TB control interventions. The purpose of this study was to identify risk factors for mortality during treatment of adult patients with pulmonary TB. Methods: A multicenter retrospective cohort study was performed at private-public mix hospitals across South Korea. Between 2015 and 2017, 3735 mortality cases of pulmonary TB were collected. All TB deaths were categorized based on cause (TB-related or non-TB-related death) and timing (early or late death). Drug-resistant TB was excluded. Results: The mean age was 74.3±13.0 years, and there were 2541 (68.0%) males. The median interval between anti-TB treatment and death was 26.0 days. There were 944 (25.3%) cases of TB-related death and 2545 (68.1%) cases of early death. Among 2791 cases of non-TB-related death, respiratory failure was the most common mode of death, followed by malignant neoplasm. In multivariate analysis, low body mass index, previously healthy individual, positive acid fast bacilli smear test result, and dyspnea were significant risk factors for both TB-related death and early death, and malignancy was a significant risk factor for both non-TB-related death and late death. Conclusion: High proportion of TB death was observed elderly patients. Majority of TB deaths were ascribed to non-TB-related causes. Early interventions identifying TB patients at high risk of death are necessary in order to reduce TB mortality.

Age-stratified trend of anti-tuberculosis drug resistance in South Korea ; a multicenter retrospective study

민진수,김주상,김형우,강지영,김용현,김진우,김성경 대한결핵 및 호흡기학회 2018 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.126 No.0

Background: The emergence of drug-resistant tuberculosis (TB) is a major obstacle for eradicating TB. We aimed to analyze the age-related trend in the rates of drug-resistant TB in South Korea. Methods: We retrospectively collected the results of phenotypic drug susceptibility test of culture confirmed TB patients from 2011 to 2018 in six university-affiliated hospitals. All the patients were stratified into age-stratified subgroups: young (0-34 years), middle-aged (35-64 years), and old (over 65 years). Proportions of drug-resistant pattern were compared among age-stratified groups. Results: In total, 1076 patients with drug-resistant TB were identified. Number of multidrug-resistant TB (MDR-TB), rifampicin- resistant TB (RR-TB), and non-MDR isoniazid-resistant TB were 353 (32.8%), 87 (8.1%), and 445 (41.4%), respectively. Proportions of both MDR-TB and RR-TB were significantly decreased as age increased (MDR-TB, 43.2% vs. 34.9% vs. 22.0%, p-value=0.000; RR-TB, 15.8% vs. 6.7% vs. 4.6%, p-value=0.000). Trend in proportion of non-MDR isoniazid- resistant TB was vice versa (26.1% vs. 43.2% vs. 49.7%, p=0.000). There were no significant changes of resistance to fluoroquinolone and second-line injectable drugs among three groups. Multivariate analysis identified that young (adjusted odds ratio [aOR] 2.64, 95% confidence interval [CI] 1.79-3.89) and middle-aged (aOR 1.69, 95% CI 1.21-2.37) groups were associated with MDR-TB compared to old group. Conclusions: A statistically significant increases in MDR- and RR-TB among younger populations were observed.

폐렴은 과연 예방 가능한가?

민진수 대한내과학회 2017 대한내과학회 추계학술대회 Vol.2017 No.2

집단시설 잠복결핵감염 검진사업에서의 잠복결핵감염 치료 완료율

민진수,김주상,김형우,임정욱,명준표,이연희,박재석,이성순,구현경,고운영,신인식,김종희,박용준,정혜란,임현우 대한결핵 및 호흡기학회 2018 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.126 No.0

배경: 세계보건기구에서는 우리나라와 같은 결핵의 중부담 국가에 대하여 잠복결핵에 대한 검진 및 치료를 적극 권장하고 있다. 국내 활동성 결핵 발생률 및 잠복결핵 유병률을 고려 시 우리나라는 잠복결핵감염의 치료 효과가 매우 클 것으로 판단이 되었다. 따라서, 정부에서는 ‘결핵안 심국가 실행계획’을 발표하였으며, 2017년 집단시설 종사자 대상 잠복결핵감염 검진사업을 실시하였다. 목적: 본 연구에서는 2017년 검진사업 때 시행된 잠복결핵감염 치료자를 확인하고, 치료 완료율을 확인하였다. 방법: 2017년에 11개의 집단시설의 종사자를 대상으로 IGRA 검사를 시행하였다. 총 139062명의 IGRA 검사 양성자 중31461명이 민간의료기관을 방문하여 잠복결핵감염 치료를 시작하였다. 11개의 집단시설을 특성에 따라 다음의 4개의 군으로 나누었으며, 각 군의 치료 완료율을 확인하였다. (가군, 어린이집, 유치원, 초중고등학교, 사회복지시설; 나군, 의료기관; 다군, 병무청신검대상자, 학교밖청소년, 고등학교1학년; 라군, 산후조리원, 교정시설, 보건내소자) 또한, 치료약제조합에 따른 치료 완료율을 확인하였다. 결과: 총 23673명이 잠복결핵치료를 완료하였으며, 평균 치료완료율은 75.3%이었다. 가군, 나군, 다군과 라군의 평균 치료완료율은 각각 76.78%, 73.5%, 71.1%와 67.4% 이었으며, 4군은 통계학적으로 유의하게 차이가 있었다. 치료약제조합에 따른 치료 완료율은 INH-RIF 3개월요법이 78.4%, RIF 4개월요법이 76.2%, INH 6개월요법이 46.9%이었으며, 통계학적으로 유의하게 차이가 있었다. 결론: 산후조리원, 교정시설, 보건내소자와 INH6개월요법은 유의하게 치료 완료율이 낮았으며, 치료완료율을 향상시키기 위한 노력이 필요하겠다.

P-44 Screening for latent tuberculosis infection among healthcare workers in an intermediate tuberculosis burden country

민진수,허중연,강은석,신윤미,안진영,최강현,이기만,정혜원 대한결핵 및 호흡기학회 2017 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.124 No.-

Background: In South Korea, a country with an intermediate Tuberculosis (TB) burden, TB infection in healthcare workers (HCWs) has been a serious occupational health issue, and periodic screening for latent TB infection (LTBI) among HCWs is recommended as part of national TB control strategy. We investigated prevalence of LTBI and risk factors among the HCWs in South Korea. Methods: Between November 2016 and May 2017, we carried out TB screening in a tertiary teaching hospital. A total of 421 HCWs received both tuberculin skin test (TST) and QuantiFERON-TB Gold In-Tube test (QFT-G) in addition to chest x-ray. Results: The mean age of subjects was 32.1 years old, and 346 (82.2%) were female. The numbers of positive results for TST and QTF-G were 47 (11.2%) and 56 (13.3%), respectively. The overall agreement between TST and QTF-G was 89.3% with kappa coefficient of 0.503. In multivariate analysis, age, type of profession, and working period were independently associated with positive TST result, while age was the only significant risk factor for positive QTF-G result. Experience of working in TB-related department was not associated with both positive TST and QTF-G results. Conclusion: Prevalence of LTBI among the HCWs in this study was not higher than general population in South Korea. Age was the most significant risk factor for positive LTBI test result. Additional studies are needed for careful selection of candidates for LTBI screening among HCWs in South Korea.

Non-Surgical Management of Critically Compromised Airway Due to Dilatation of Interposed Colon

민진수,조영재 대한결핵및호흡기학회 2016 Tuberculosis and Respiratory Diseases Vol.79 No.2

We present a rare case of critically compromised airway secondary to a massively dilated sequestered colon conduit after several revision surgeries. A 71-year-old male patient had several operations after the diagnosis of gastric cancer. After initial treatment of pneumonia in the pulmonology department, he was transferred to the surgery department for feeding jejunostomy because of recurrent aspiration. However, he had respiratory failure requiring mechanical ventilation. The chest computed tomography (CT) scan showed pneumonic consolidation at both lower lungs and massive dilatation of the substernal interposed colon compressing the trachea. The dilated interposed colon was originated from the right colon, which was sequestered after the recent esophageal reconstruction with left colon interposition resulting blind pouch at both ends. It was treated with CT-guided pigtail catheter drainage via right supraclavicular route, which was left in place for 2 weeks, and then removed. The patient remained well clinically, and was discharged home.