Clinical and Bacteriologic Characteristics of Retreated Tuberculosis Patients

재치료 폐결핵환자의 임상적 세균학적 특성

Background: Although pulmonary tuberculosis is effectively controlled with 6 months or 9 months short course standard regimens, comparable numbers of treatment failures ensued because of inadequate treatment mainly due to patient's poor compliance. Indequate treatment with standard regimens during initial treatment may cause emergence of drug resistance and prolong the duration of chemotherapy. Also it may make the patient lesser compliant and finally increase the morbidity and the mortality. Methods: A clinical study was done to evaluate clinical and bacteriological characteristics of 94 patients who were retreated for pulmonary tuberculosis. Results: 1) 62 of the 94 patients were male and 32 patients were female. Mean age is 51 years old in male and 45 years old in female. 2) The extent of the disease on the chest radiograph was minimal in 10(11.1%) patients, moderate in 31(33.3%) patients, and far advanced in 52(55.6%) patients. 3) On sputum bacteriologic examination, 73(77.7%) patients were positive in sputum AFB smear and/or culture for Mycobacterium tuberculosis. 4) Results of drug sensitivity test performed in 42 patients showed that the resistance to one drug is in 9(20.5%) patients, two drugs in 18(40.8%) patients, and more than three drugs in 14(31.8%) patients. 5) Poor patient's compliance was the leading cause of the retreatment of pulmonary tuberculosis(43.6%) 6) Only 24(25.5%) patients of the 94 retreatment patients were successfully treated and 39(41.6%) patients were dropped out during follow-up. Conclusion: We concluded that poor patient's compliance was the most important cause of treatment failure not only in primary treatment patients but also in retreatment patients. Primary treatment of pulmonary tuberculosis should be completed under strict monitoring of the patient because significant number of retreatment patients had multiple drug resistance and poor outcome.

연구배경: 폐결핵은 처음 발병하였을 때 표준처방에 의하여 적절히 치료하면 대부분 완치할 수 있는 질환이나 실제로 상당수의 환자들이 부적절한 치료를 함으로써 악화되고 장기적인 치료를 받는 경우가 있다. 또한 약제 내성이 발생할 경우 초치료 약제보다 항균력이 약한 약제들로 치료하게 됨으로써 치료기간이 길어짐은 물론 정상적인 생활을 하지 못할 정도로 심한 장애를 초래하거나 사망하는 경우까지도 있다. 방법: 저자등은 초치료에 실패하거나 재발한 폐결핵 환자들의 특성과 문제점을 알아보고자 1986년 3월부터 90년 2월까지 입원하여 치료한 폐결핵환자 484명 가운데 94명의 재치료 환자들의 기록을 조사하여 다음과 같은 결과를 얻었다. 결과: 1) 총 재치료환자 94명중 남자 62명, 여자 32명이며 평균연령은 남자 $51.43{\pm}15.56$, 여자 $45.00{\pm}18.40$세 이었다. 2) 흉부엑스선상 경증이 10명(11.1%), 중등도가 31명(33.3%), 중증이 52명(55.6%)이었다. 3) 객담내 균양성환자가 73명 이었다. 4) 약제감수성검사를 시행한 42명중 1제 내성자가 9명(20.5%), 2제 내성자가 18명(40.8%), 3제이상 내성자가 14명(31.8%)이었다. 5) 표준처방에 의한 초치료를 완료하지 못하였던 경우가 41명(43.6%)이었으며 재치료시 완치한 환자는 24명(25.5%)에 불과한 반면 도중에 환자가 치료를 포기한 경우가 39명(41.6%)나 되었다. 결론: 재치료시 중요한 치료실패 원인은 환자의 중도탈락 이었으며, 따라서 초치료 및 재치료시 철저한 환자관리가 이루어져야 할것으로 생각된다.