Epidemiology of Drug-Resistant Tuberculosis

Abstract

As we move into the era of the Sustainable Development Goals (SDGs), the World Health Organization (WHO) has developed the End TB strategy 2016-2035 with a goal to end the global epidemic of tuberculosis (TB) by 2035. Achieving the targets laid out in the Strategy will require strengthening of the whole TB diagnosis and treatment cascade, including improved case detection, the establishment of universal drug susceptibility testing and rapid treatment initiation. An estimated 3.9% of new TB cases and 21% of previously treated cases had rifampicin-resistant (RR) or multidrug-resistant (MDR) TB in 2015. These levels have remained stable over time, although limited data are available from major high burden settings. In addition to the emergence of drug resistance due to inadequate treatment, there is growing evidence that direct transmission is a large contributor to the RR/MDR-TB epidemic. Only 340,000 of the estimated 580,000 incident cases of RR/MDR-TB were notified to WHO in 2015. Among these, only 125,000 were initiated on second-line treatment. RR/MDR-TB epidemics are likely to be driven by direct transmission. The most important risk factor for MDR-TB is a history of previous treatment. Other risk factors vary according to setting but can include hospitalisation, incarceration and HIV infection. Children have the same risk of MDR-TB as adults and represent a diagnostic and treatment challenge. Rapid molecular technologies have revolutionized the diagnosis of drug-resistant TB. Until capacity can be established to test every TB patient for rifampicin resistance, countries should focus on gradually expanding their coverage of testing. DNA sequencing technologies are being increasingly incorporated into patient management and drug resistance surveillance. They offer additional benefits over conventional culture-based phenotypic testing, including a faster turn-around time for results, assessment of resistance patterns to a range of drugs, and investigation of strain clustering and transmission.

Assessment of multidrug-resistant tuberculosis (MDR-TB) treatment outcomes in Sudan; findings and implications

“…TB-drug resistance generally occurs due to prescribing malpractice and poor adherence to anti-TB medications, with the spread of resistance enhanced by HIV co-infection [3,12,13]. The consequences of primary infection can also result in drug resistance.…”

Manuka honey chelates iron and impacts iron regulation in key bacterial pathogens

“…Long-term antibiotic use has allowed microbes to develop resistance and cause infectious diseases that were once treatable (Lister et al 2009;Aminov, 2017;Dean et al 2017;Dickey et al 2017;Martens and Demain 2017). Thus, it is urgent that novel antimicrobial agents are developed and implemented.…”

Clinical Profile, Drug Utilization Pattern and Adverse Drug Reactions of Anti-tubercular Drugs at DOTS Center in a Tertiary Hospital

“…Similar finding was also reported by Swaminathan et al and Dean et al in which MDR-TB was detected in 4% and 3.9% of the patients respectively. 22,23 Almost 20% of all TB strains worldwide are resistant to at least one major TB drug, including isoniazid. Drug resistant TB is associated with greater morbidity compared to drug susceptible TB.…”