Determinants of Drug Resistance in Previously-Treated Pulmonary Tuberculosis Patients Registered at a Chest Clinic in South Delhi, India

Abstract

Introduction Drug-resistant tuberculosis (DR-TB) is a major concern to effective control of tuberculosis (TB) in India and the likelihood of drug resistance increases with repeated exposure to anti-TB drugs. India has emerged as one of the leading contributors of DR-TB in the world posing a major threat to TB control. In the current study, we aim to find the burden and factors associated with drug resistance in previously treated pulmonary TB patients. Methods A cross-sectional study was conducted among 230 previously treated pulmonary TB patients registered with Directly Observed Treatment, Short-course (DOTS) centers under Nehru Nagar Chest clinic in Delhi, India. The participants were selected consecutively as they registered with the chest clinic. A predesigned, pretested, semi-structured questionnaire in the Hindi language used to collect socio-demographic data and factors associated with the development of drug resistance. Physical examination of all the participants was done (height, weight, pallor). Data were analyzed using SPSS version 21. Binary logistic regression analysis was used to identify independent risk factors of drug resistance. Results Of 230 previously treated pulmonary TB patients, 80 (34.8% (95% CI:28.7-40.9%)) were drug-resistant. Age (p=0.021), ever consumption of alcohol (p= 0.001), pallor (p=0.06), BMI (p=0.028), fasting blood sugar (p=0.001), treatment failure (p=0.005) and the number of prior courses of anti-tuberculosis treatment (ATT) taken (p=0.004) were significantly associated with drug resistance. On applying binary logistic regression analysis, independently associated factors with drug resistance were ever consumption of alcohol, pallor, high fasting blood sugar level, previous treatment failure patients and the number of prior courses of ATT (p<0.05). Conclusion The findings of this study revealed that patients who had pallor, high fasting blood sugar, treatment failure and who had two or more prior courses of ATT were more likely to have DR-TB. Identifying the risk factors for drug-resistant TB is essential in facilitating the government to draw public health interventions. Further research is warranted to explore the causal associations.

Analysis of drug resistance in pulmonary tuberculosis patients with positive sputum tuberculosis culture in Northeast China

“…Additionally, the production of drug-resistant strains, low patient immunity, and comorbidities such as diabetes or other pulmonary infections are also factors that cannot be ignored ( Shivekar et al, 2020 ; Antonio-Arques et al, 2021 ; Antimicrobial Resistance Collaborators, 2022 ; Williams et al, 2022 ). However, this study did not find an association between BMI and binding resistance, while previous studies have shown that higher BMI was negatively associated with being a relapse/defaulter/treatment-failure cases ( Goswami et al, 2014 ; Sharma et al, 2019 ). Improved nutritional status, which can positively influence immunity and treatment outcome, could be cited as a possible explanation; but their findings could also have been an artifact of reverse causation, as implicated by deterioration of general health among relapse/defaulter/treatment-failure cases.…”

Patterns of Presentation of Drug-Resistant Tuberculosis in Nigeria: A Retrospective File Review

“…Similar to our study, patients who received more than two previous anti-TB treatments (ATT) (compared to one) had a 2.4 times higher risk of DR-TB in India and 3.25 times increased odds of confirmed MDR-TB in Mali [31,32], while a study from Ethiopia found an association between two or more previous TB treatments and any type of drug resistance [30]. In Bangladesh, 54% of the 293 TB patients who had received TB treatment more than once were MDR-TB, and 97% MDR-TB patients in the Philippines reported a previously failed Category 2 treatment, indicating they were treated at least twice for TB in the past [33,34].…”

The Evolution in Pharmacology of Infectious Diseases: 2022

“…Additionally, the production of drug-resistant strains, low patient immunity, and comorbidities such as diabetes or other pulmonary infections are also factors that cannot be ignored (Shivekar et al, 2020;Antonio-Arques et al, 2021;Antimicrobial Resistance Collaborators, 2022;Williams et al, 2022). However, this study did not find an association between BMI and binding resistance, while previous studies have shown that higher BMI was negatively associated with being a relapse/defaulter/treatment-failure cases (Goswami et al, 2014;Sharma et al, 2019). Improved nutritional status, which can positively influence immunity and treatment outcome, could be cited as a possible explanation; but their findings could also have been an artifact of reverse causation, as implicated by deterioration of general health among relapse/defaulter/treatment-failure cases.…”