M N Massi1, S Wahyuni, H Halik, I Yusuf, F J Leong, T Dick, S Phyu. 1. Novartis Institute for Tropical Diseases-Eijkman Institute-Hasanuddin University Clinical Research Initiative, Kemerdekaan, South Sulawesi, Makassar, Indonesia. nasrum.massi@novartis.com
Abstract
SETTING: Government tuberculosis (TB) diagnostic and treatment centres, Makassar, Indonesia. OBJECTIVE: To determine the proportions and patterns of resistance to commonly used TB drugs (isoniazid [INH], rifampicin, ethambutol and streptomycin) among pulmonary TB patients and assess potential risk factors for drug resistance. DESIGN: Cross-sectional study. RESULTS: Of 657 recruited patients, 234 were culture-positive. Drug susceptibility testing (DST) results were available for 216 patients. Among these, 197 were infected with Mycobacterium tuberculosis complex (145 new and 52 previously treated). Isolates from 89 new (61.4%) and 31 previously treated (59.6%) patients were susceptible to all four drugs. Resistance to INH was high among both patient groups (28.3% of new vs. 34.6% of previously treated). Multidrug-resistant TB (MDR-TB) cases accounted for respectively 4.1% and 19.2% of these patients. Resistance to >2 drugs was high among previously treated patients (19.2%). MDR-TB cases were more likely to have a history of excess alcohol use (adjusted OR 4.01, 95%CI 1.28-12.53) and previous TB treatment (adjusted OR 6.28, 95%CI 2.01-19.64). CONCLUSIONS: Regardless of previous treatment history, many culture-positive TB patients were infected with INH-resistant isolates, and a significant proportion of previously treated patients were infected with MDR-TB. Treating culture-positive TB patients, especially previously treated patients, based on DST results should therefore be considered.
SETTING: Government tuberculosis (TB) diagnostic and treatment centres, Makassar, Indonesia. OBJECTIVE: To determine the proportions and patterns of resistance to commonly used TB drugs (isoniazid [INH], rifampicin, ethambutol and streptomycin) among pulmonary TBpatients and assess potential risk factors for drug resistance. DESIGN: Cross-sectional study. RESULTS: Of 657 recruited patients, 234 were culture-positive. Drug susceptibility testing (DST) results were available for 216 patients. Among these, 197 were infected with Mycobacterium tuberculosis complex (145 new and 52 previously treated). Isolates from 89 new (61.4%) and 31 previously treated (59.6%) patients were susceptible to all four drugs. Resistance to INH was high among both patient groups (28.3% of new vs. 34.6% of previously treated). Multidrug-resistant TB (MDR-TB) cases accounted for respectively 4.1% and 19.2% of these patients. Resistance to >2 drugs was high among previously treated patients (19.2%). MDR-TB cases were more likely to have a history of excess alcohol use (adjusted OR 4.01, 95%CI 1.28-12.53) and previous TB treatment (adjusted OR 6.28, 95%CI 2.01-19.64). CONCLUSIONS: Regardless of previous treatment history, many culture-positive TB patients were infected with INH-resistant isolates, and a significant proportion of previously treated patients were infected with MDR-TB. Treating culture-positive TB patients, especially previously treated patients, based on DST results should therefore be considered.
Authors: A C Miller; I Y Gelmanova; S Keshavjee; S Atwood; G Yanova; S Mishustin; J J Furin; S S Shin Journal: Int J Tuberc Lung Dis Date: 2012-04-09 Impact factor: 2.373