Risk Factors for MDR and XDR-TB in a Tertiary Referral Hospital in India

Abstract

BackgroundIndia has a high burden of drug resistant TB, although there are few data on XDR-TB. Although XDR-TB has existed previously in India, the definition has not been widely applied, and surveillance using second line drug susceptibility testing has not been performed. Our objective was to analyze clinical and demographic risk factors associated with isolation of MDR and XDR TB as compared to susceptible controls, at a tertiary center.Methodology/FindingsRetrospective chart review based on positive cultures isolated in a high volume mycobacteriology laboratory between 2002 and 2007. 47 XDR, 30 MDR and 117 susceptible controls were examined. Drug resistant cases were less likely to be extrapulmonary, and had received more previous treatment regimens. Significant risk factors for XDR-TB included residence outside the local state (OR 7.43, 3.07-18.0) and care costs subsidized (OR 0.23, 0.097-0.54) in bivariate analysis and previous use of a fluoroquinolone and injectable agent (other than streptomycin) (OR 7.00, 95% C.I. 1.14-43.03) and an initial treatment regimen which did not follow national guidelines (OR 5.68, 1.24-25.96) in multivariate analysis. Cavitation and HIV did not influence drug resistance.Conclusions/SignificanceThere is significant selection bias in the sample available. Selection pressure from previous treatment and an inadequate initial regimen increases risk of drug resistance. Local patients and those requiring financial subsidies may be at lower risk of XDR-TB.

Faktor-faktor yang mempengaruhi kejadian Multi Drug Resistance Tuberkulosis (MDR-TB)

“…Sedangkan menurut Caminero, beberapa faktor yang dapat menyebabkan MDR-TB meliputi tidak mengimplementasikan DOTS sebagai terapi Tuberkulosis, status gizi, dan tingginya infeksi HIV.5 Selain itu, menurut Balaji dkk, ada beberapa faktor lain yang dapat menyebabkan MDR-TB seperti merokok, konsumsi alkohol, diabetes, umur, dan jenis kelamin wanita. 10 Berdasarkan uraian diatas, terdapat banyak faktor yang berkontribusi terhadap terjadinya kasus MDR -TB. Oleh karenanya, penulis merasa penting untuk meneliti tentang analisis faktor resiko yang berpengaruh dengan kejadian MDR -TB untuk menurunkan prevalensi kasus MDR-TB yang terjadi di Indonesia.…”

A Comparative Study of Drug Susceptibility Testing Techniques for Identification of Drug Resistant TB in a Tertiary Care Centre, South India

“…Clinical outcomes of the patients with MDR were also observed in our study through chart reviews and telephone calls, but only a few could be followed up. Among those patients, the presence of high risk factors-diabetes mellitus, HIV, smoking, and prior treatment with ATT were noted [24]. These risk factors not only increase the risk of active tuberculosis, but also increase the risk for Drug Resistant TB.…”

Multi-drug resistant tuberculosis and HIV-infection

“…в госпитале Tamil Nadu (Индия) с помощью многофакторного анализа проводилось сравнение больных туберкулезом с ШЛУ (n = 47), МЛУ (n = 30) и лекарственно чувствительным (n = 117). По результатам сравнения оказалось, что наличие каверн и ВИЧ инфекции достоверно не связано с появлением ШЛУ туберкулеза [35].…”