Determinant factors of drug resistant tuberculosis in Iran, a case control study

Abstract

Introduction: Drug resistance is one of the critical aspects had to be considered in the tuberculosis control program. Factors related to drug resistance are different in geographic regions and vary during the time. The present study aims to determine the risk factors of drug resistance among TB patients in northern of Iran. Methods: In this case control study, 22 cases (drug resistant TB patients) and 88 controls (TB patients selected out of those with successive treatment) were randomly selected from a cohort of TB patients in Northern of Iran. The required information was collected from TB registration software in Mazandaran University of Medical Sciences. Results: Of 22 drug resistant TB patients, resistance to isoniazid, rifampin and also multidrug resistance were observed in 10(9.1%), 3(2.7%) and 9(8.2%) respectively. Moreover, 22.2% of MDR cases, 66.7% of rifampin resistant cases and 40% of isoniazid resistant patients had experienced previous TB treatment (p = 0.363). Logistic regression models showed that the history of previous treatment was significantly associated with drug resistance (OR = 16.55, 95% CI = 2.83-96.89). Conclusion: History of previous anti-TB treatment can be a determinant factor for TB drug resistance.

Determinants of Multi-Drug Resistant Tuberculosis Among Patients Attending Anti-Tuberculosis Treatment From Peripheral Districts, Southern Ethiopia, 2019: a Case Control Study

“…This was in line with the study that was conducted in East Shoa (11). However, MDR-TB was not associated with residence according to the studies that were conducted in Jimma (13), China (26) and Iran (27). This difference might be due to access of TB services nearby and low knowledge of TB for drug adherence, transportation problem, inadequate social support and fear of stigma to complete anti-TB drugs.…”

“…And previous treatment was a major predictor of MDR-TB in this study. Similar ndings were found in a number of studies from different countries including the Ethiopia, East Shoa(11), Amhara regional state(32), Addis Ababa(10), Iran and neighboring countries (38),Iran (27),Nepal (39),China(26),Sub-Saharan countries review(9), retrospective study in Nigeria(40), Equatorial Guinea(34), Tanzania(33), USA(4). Systematic review and meta-analysis in Ethiopia(12) revealed previous treatment was a major determinant of MDR-TB, systematic review in Europe (41).…”

“…A higher chance of acquiring a drug resistant strain by droplets and aerosol from individuals infected with multidrug resistant strain (6,37). However, a contact history in Iran (27) had no association with MDR-TB .This could be due to a small number of cases in Iran that lacks adequate power to identify association with MDR-TB.…”

Modifiable and non-modifiable factors on previous tuberculosis treatment as a predisposition of multi drug resistance tuberculosis (mdr-tb): scoping review

“…Resistance to rifampicin and isoniazid is a resistance that often occurs when undergoing tuberculosis treatment, this resistance allows for a wider and more difficult resistance called XDR-TB (Extensively drug resisten tuberculosis). 50 Previous tuberculosis treatment was the most significant predisposing factor causing resistance, this was stated by Mesfin et al in a study conducted in Ethiopia, 27 the same thing was stated by Arora et al in an article discussing drug resistance tuberculosis tuberculosis; 49 similar findings in a study in western France, 37 northern part of Iran, 21 Henan Province China, 5 Malaysia 32 and research in Espírito Santo, Brazil. 40 The results of this study are somewhat different from the research conducted in Serbia by Stosic et al which stated that a significant predisposing factor for drug resistance was an economic factor.…”

“…Very important to identify matters related to the success of treatment in order to avoid resistance. 21 Risk factors for resistance include those who relapse after receiving successful treatment, those who return after failure, and those who start receiving a treatment regimen after experiencing previous treatment failure. 5 Some of the things that cause failure are drugs used to treat TB are not used as prescribed.…”