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조경욱,이소연,강미란,성흥섭,김미나,심태선 대한결핵 및 호흡기학회 2016 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.121 No.-
Backgrounds: We investigated (1) the frequency and common types of disputed rpoB mutations; and (2) the treatment outcomes for patients with M.tb isolates containing these mutations. In addition, we sought to develop a rapid molecular test to detect the disputed rpoB mutations. Methods: The patient data was derived from Asan Medical Center. We also identified M.tb strains from which rpoB sequencing revealed disputed mutations at the International Tuberculosis Research Center (ITRC) to investigate the most common types. A rapid molecular test was developed with YD Diagnostics. Results: Of the 130 patients shown as rifampin resistant on the MTBDRplus assay, the results of the DST indicated that 15 patients were rifampin susceptible. Among these 15 patients, the rpoB sequencing from nine patients revealed disputed rpoB mutations. Thus, the frequency of disputed rpoB mutations was at least 6.9% (9/130) of cases with rifampin-resistant on the MTBDRplus assay. All nine patients received individualized treatment regimens, with the majority exhibiting favorable outcomes. The sequencing results from our hospital and the ITRC revealed that the common types of disputed mutations in order of frequency are as follows: CTG511CCG; GAC516TAC; CTG533CCG; CAC526CTC; and CAC526AAC. Based on these results, we have developed a rapid molecular test by supplementing the probes to the MolecuTech REBA MTB-MDR kit (YD Diagnostics, South Korea). Conclusion: Disputed rpoB mutations are not quite rare in South Korea. The rapid molecular test was successfully developed after identifying common types.
Preventing the Transmission of Tuberculosis in Health Care Settings: Administrative Control
조경욱 대한결핵및호흡기학회 2017 Tuberculosis and Respiratory Diseases Vol.80 No.1
It is well established that health care workers (HCWs) have a considerably higher risk of occupationally acquired tuberculosis (TB). To reduce the transmission of TB to HCWs and patients, TB infection control programs should be implemented in health care settings. The first and most important level of all protection and control programs is administrative control. Its goals are to prevent HCWs, other staff, and patients from being exposed to TB, and to reduce the transmission of infection by ensuring rapid diagnosis and treatment of affected individuals. Administrative control measures recommended by the United States Centers for Disease Control and Prevention and the World Health Organization include prompt identification of people with TB symptoms, isolation of infectious patients, control of the spread of the pathogen, and minimization of time spent in health care facilities. Another key component of measures undertaken is the baseline and serial screening for latent TB infection in HCWs who are at risk of exposure to TB. Although the interferon-gamma release assay has some advantages over the tuberculin skin test, the former has serious limitations, mostly due to its high conversion rate.
조경욱,김예지,박경민,김선옥,김영학,강지은,심태선,홍석찬 대한결핵 및 호흡기학회 2016 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.121 No.-
Backgrounds: We investigated whether the incidence of cardiovascular disease is (1) higher during the course of active tuberculosis, and (2) related to pyrazinamide use. Methods: The population-based retrospective cohort study was conducted in active tuberculosis patients treated with the standard regimen and identified using the Korean Health Insurance Review and Assessment Service database from January 1, 2010 to December 31, 2014. The primary outcome was hospitalization for cardiovascular disease combined with cerebrovascular disease and acute myocardial infarction. The standardized incidence ratio (SIR) was calculated by comparing the active tuberculosis patients with the general population stratified by age and sex. The adjusted hazard ratio (HR) among tuberculosis patients was evaluated according to the treatment phase. Results: A total of 69023 active tuberculosis patients who received standard antituberculosis treatment were identified through eligibility screening. The incidence of cardiovascular disease in these patients was 7·79 per 1000 person-years. SIR was significantly higher in these patients than in the age- and sex-stratified population (SIR, 2.89; 95% CI 2.58-3.23). After covariate adjustment, the risk of cardiovascular disease development was higher during the pyrazinamide-containing intensive phase than during the continuation phase (adjusted HR 2.20, 95% CI 1.33-3.62). Conclusion: These results suggest that active tuberculosis can be considered a pertinent risk factor for cardiovascular disease, particularly in the intensive phase.
조경욱,강영애,김미혜,김주상,김현국,류지원,목정하,박혜경,이영석,임재준,전두수,최상봉,허은영,심태선 대한결핵 및 호흡기학회 2013 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.116 No.-
목적: 신속감수성검사(MTBDRplus assay)로 isoniazid와 rifampicin 감수성으로 판명된 폐결핵 환자에서 ethambutol을 제외한 3제 치료의 유용성을 확인한다. 방법: 13개 병원에서 항산균도말 또는 배양 양성 폐결핵 환자들 중 4제 표준치료 시작 전이거나 시작 후 2주 이내인 환자들을 대상으로 한다. MTBDRplus assay 시행 후 무작위배정에 의해 ethambutol 포함(4제군)과 제외 치료군(3제군)으로 구분하여 치료하고 치료 결과 및 치료종료후 1년 까지의 재발률을 비교한다. 양 군 합하여 800명을 대상으로 한 전향적 연구이며, 중간 결과를 분석하였다. 결과: 2012년 11월 12일부터 2013년 8월 31일까지 174명이 참여하였다. 신속감수성검사에서 isoniazid 또는 rifampicin에 내성을 보인18명 등을 포함한 36명이 연구에서 제외되었다. 나머지 138명에서 연구가 진행 중으로 ethambutol 포함군 73명, 제외군 65명으로 배정되었다. 신속감수성검사는 156명에서 결과가 확인되었고, 138명(88.5%)에서 두 약제에 모두 감수성을 보였으며 공동유무, 도말양성여부, 이전 결핵치료력에 따라서 감수성 차이는 없었다. 신속 및 고체배지를 이용한 감수성검사 결과 비교시 92.1% (105/114)에서 두 약제 모두 일치하였다. 현재까지 치료종료는 3제군 및 4제군에서 각각 15명과 17명, 치료실패는 양 군 모두에서 없었다. 결론: 폐결핵환자의 4제 표준치료에서 신속감수성검사 결과에 따라서 ethambutol을 조기에 제외하는 연구가 진행 중으로 3년간 총 800명을 목표로 하고 있다.
조경욱,이소연,강미란,성흥섭,김미나,심태선 대한결핵및호흡기학회 2017 Tuberculosis and Respiratory Diseases Vol.80 No.3
Background: A disputed rpoB mutation is a specific type of rpoB mutation that can cause low-level resistances to rifampin (RIF). Here, we aimed to assess the frequency and types of disputed rpoB mutations in Mycobacterium tuberculosis isolates from South Korea. Methods: Between August 2009 and December 2015, 130 patients exhibited RIF resistance on the MTBDR plus assay at Asan Medical Center. Among these cases, we identified the strains with disputed rpoB mutation by rpoB sequencing analysis, as well as among the M. tuberculosis strains from the International Tuberculosis Research Center (ITRC). Results: Among our cases, disputed rpoB mutations led to RIF resistance in at least 6.9% (9/130) of the strains that also exhibited RIF resistance on the MTBDR plus assay. Moreover, at the ITRC, sequencing of the rpoB gene of 170 strains with the rpoB mutation indicated that 23 strains (13.5%) had the disputed mutations. By combining the findings from the 32 strains from our center and the ITRC, we identified the type of disputed rpoB mutation as follows: CTG511CCG (L511P, n=8), GAC516TAC (D516Y, n=8), CTG533CCG (L533P, n=8), CAC526CTC (H526L, n=4), CAC526AAC (H526N, n=3), and ATG515GTG (M515V, n=1). Conclusion: Disputed rpoB mutations do not seem to be rare among the strains exhibiting RIF resistance in South Korea.
조경욱,홍상범,김동관,정성호,김형렬,최세훈,이근동,이상오,도경현,채은진,최인철,최대기,김인옥,박승일,심태선 대한결핵및호흡기학회 2019 Tuberculosis and Respiratory Diseases Vol.82 No.4
Background: Recently, the number of lung transplants in South Korea has increased. However, the long-term outcome data is limited. In this study, we aimed to investigate the long-term outcomes of adult lung transplantation recipients. Methods: Among the patients that underwent lung transplantation at a tertiary referral center in South Korea between 2008 and 2017, adults patient who underwent deceased-donor lung transplantation with available follow-up data were enrolled. Their medical records were retrospectively reviewed. Results: Through eligibility screening, we identified 60 adult patients that underwent lung (n=51) or heart-lung transplantation (n=9) during the observation period. Idiopathic pulmonary fibrosis (46.7%, 28/60) was the most frequent cause of lung transplantation. For all the 60 patients, the median follow-up duration for post-transplantation was 2.6 years (range, 0.01–7.6). During the post-transplantation follow-up period, 19 patients (31.7%) died at a median duration of 194 days. The survival rates were 75.5%, 67.6%, and 61.8% at 1 year, 3 years, and 5 years, respectively. Out of the 60 patients, 8 (13.3%) were diagnosed with chronic lung allograft dysfunction (CLAD), after a mean duration of 3.3±2.8 years post-transplantation. The CLAD development rate was 0%, 17.7%, and 25.8% at 1 year, 3 years, and 5 years, respectively. The most common newly developed post-transplantation comorbidity was the chronic kidney disease (CKD; 54.0%), followed by diabetes mellitus (25.9%). Conclusion: Among the adult lung transplantation recipients at a South Korea tertiary referral center, the long-term survival rates were favorable. The proportion of patients who developed CLAD was not substantial. CKD was the most common post-transplantation comorbidity.