Changing patterns and trends of multidrug-resistant tuberculosis at referral centre in Northern India: A 4-year experience

Maurya, Anand Kumar; Singh, Amresh Kumar; Kumar, Mandhir; Umrao, Jyoti; Kant, Surya; Nag, Vijayalakshmi; Kushwaha, Ramesh Kumar; Dhole, Tapan N.

doi:10.4103/0255-0857.108720

Cited by 20 publications

(7 citation statements)

References 10 publications

(9 reference statements)

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“…In a review on drug resistance in tuberculosis, Dheda et al 22 have observed that the prevalence of MDR-TB has increased globally in the past decade and is likely to continue to increase in many areas in resource-poor settings. A recent study from north India also confirmed an increase in MDR-TB during the past few years in our country 23 . The WHO Global Report 2014, estimated primary MDR-TB as 2.2 per cent and among previously treated patients as 15 per cent in our country during 2013 1 .…”

Section: Discussionsupporting

confidence: 86%

Multidrug-resistant pulmonary & extrapulmonary tuberculosis: A 13 years retrospective hospital-based analysis

2015

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Background & objectives:Multidrug-resistant tuberculosis (MDR-TB) is a public health problem of great significance in India. In the present study an attempt was made to analyse the progression of MDR-TB pattern during a course of 13 years (2000-2012) among the patient population at a tertiary care centre in New Delhi, India.Methods:Mycobacterial isolates obtained on Lowenstein-Jensen (L-J) medium/BacT/ALERT 3D were identified using AccuProbe molecular identification system, routine biochemical tests or GenoType Mycobacteria CM. Antimycobacterial susceptibility testing was performed using resistance ratio method on L-J medium (2000-2004) and one per cent proportion method on BacT/ALERT 3D system (2005-2012).Results:Of the total 14,849 samples subjected to mycobacterial culture, 6569 pulmonary and 8280 extrapulmonary, 2364 were detected positive for mycobacteria. The average percentage positivity rate was 15.9 per cent (18.9 and 13.6% in case of pulmonary and extrapulmonary samples, respectively). Our study revealed a significant increase (P<0.001) in multidrug resistance by 12 per cent (4.7% in 2000 to 19.8% in 2012). MDR-TB was more in case of pulmonary (28.2%) than extrapulmonary (11.6%) TB (P<0.001). Only 6.5 per cent (154) of mycobacterial isolates were non-tuberculous mycobacteria and rapid growers represented by Mycobacterium fortuitum and M. abscessus were the most commonly isolated species.Interpretation & conclusions:Increase in prevalence of MDR-TB by 12 per cent in the past 13 years is alarming. Policy modifications may have to be done to strengthen the existing TB control programmes to encourage contact tracing and culture and drug susceptibility testing for all smear positive pulmonary cases to ensure early and appropriate therapy.

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Section: Discussionsupporting

confidence: 86%

Multidrug-resistant pulmonary & extrapulmonary tuberculosis: A 13 years retrospective hospital-based analysis

2015

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“…These findings probably serve as a grim reminder of the prevailing complex scenario of PTB in the largest metropolitan city of eastern India, which is not unlike rest of the country. [14] , [23] , [24] It is worth noting that the burden of MDR-PTB among newly infected [24] and previously treated cases [23] in most Indian states have consistently remained high during past two decades, and even more alarmingly, a recent report suggested a gradually increasing trend in MDR-PTB prevalence across the country. [14] In view of the above, our study findings convey that Kolkata is no exception.…”

Section: Discussionmentioning

confidence: 99%

“… [7] , [12] , [13] Data on drug resistance pattern prevailing in the community are scarcely available, and there exists considerable inconsistency among the published findings. [6] , [10] , [14] A 2012 country-level estimate by WHO reported India’s burden of MDR-TB to be moderately high (about 2.2% of new TB cases and 15% of retreatment cases), [1] however, there was substantial heterogeneity across reviewed studies.…”

Section: Introductionmentioning

confidence: 99%

Correlates of Treatment Outcomes and Drug Resistance among Pulmonary Tuberculosis Patients Attending Tertiary Care Hospitals of Kolkata, India

et al. 2014

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BackgroundWorldwide highest number of new pulmonary tuberculosis (PTB) cases, was reported from India in 2012. Adverse treatment outcomes and emergence of drug resistance further complicated the prevailing scenario owing to increased duration, cost and toxicity associated with the treatment of drug-resistant cases. Hence to reinforce India’s fight against TB, identification of the correlates of adverse treatment outcomes and drug resistance, seemed critical.MethodsTo estimate the associations between diagnostic findings, patient types (based on treatment outcomes), drug resistance and socio-demographic characteristics of PTB patients, a cross-sectional study was conducted in two tertiary-care hospitals in Kolkata between April 2010 and March 2013. Altogether, 350 consenting Mycobacterium tuberculosis sputum-culture positive PTB patients were interviewed about their socio-demographic background, evaluated regarding their X-ray findings (minimal/moderately advanced/far advanced/cavities), sputum-smear positivity, and treatment history/outcomes (new/defaulter/relapse/treatment-failure cases). Multiple-allele-specific polymerase chain reaction (MAS-PCR) was conducted to diagnose drug resistance.ResultsAmong all participants, 31.43% were newly diagnosed, while 44%, 15.43% and 9.14% patients fell into the categories of relapsed, defaulters and treatment-failures, respectively. 12.29% were multi-drug-resistant (MDR: resistant to at least isoniazid and rifampicin), 57.71% had non-MDR two-drug resistance and 12% had single-drug resistance. Subjects with higher BMI had lower odds of being a relapse/defaulter/treatment failure case while females were more likely to be defaulters and older age-groups had more relapse. Elderly, females, unmarried, those with low BMI and higher grade of sputum-smear positivity were more likely to have advanced X-ray features. Higher grade of sputum-smear positivity and advanced chest X-ray findings were associated with relapse/treatment-failures. Elderly, unmarried, relapse/defaulter/treatment-failure cases had higher odds and those with higher BMI and moderately/far advanced X-ray findings had lower odds of having MDR/non-MDR two-drug resistant PTB.ConclusionTargeted intervention and appropriate counseling are needed urgently to prevent adverse treatment outcomes and development of drug resistance among PTB patients in Kolkata.

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“…The reason for the high numbers of RIF resistant samples in our study (~34%) can be explained firstly, by the fact that anti-tubercular therapy (ATT) status of these samples was not known prior to analysis, and secondly, the samples used in this study were collected from NITRD hospital, which is a tertiary care hospital, and several of the patients attending the Hospital are previously treated [ 32 ]. High levels of resistance have been reported previously from tertiary care hospitals in both new and previously treated TB cases [ 33 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

Direct detection of Mycobacterium tuberculosis rifampin resistance in bio-safe stained sputum smears

et al. 2017

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Direct smear microscopy of sputum forms the mainstay of TB diagnosis in resource-limited settings. Stained sputum smear slides can serve as a ready-made resource to transport sputum for molecular drug susceptibility testing. However, bio-safety is a major concern during transport of sputum/stained slides and for laboratory workers engaged in processing Mycobacterium tuberculosis infected sputum specimens. In this study, a bio-safe USP (Universal Sample Processing) concentration-based sputum processing method (Bio-safe method) was assessed on 87 M. tuberculosis culture positive sputum samples. Samples were processed for Ziehl-Neelsen (ZN) smear, liquid culture and DNA isolation. DNA isolated directly from sputum was subjected to an IS6110 PCR assay. Both sputum DNA and DNA extracted from bio-safe ZN concentrated smear slides were subjected to rpoB PCR and simultaneously assessed by DNA sequencing for determining rifampin (RIF) resistance. All sputum samples were rendered sterile by Bio-safe method. Bio-safe smears exhibited a 5% increment in positivity over direct smear with a 14% increment in smear grade status. All samples were positive for IS6110 and rpoB PCR. Thirty four percent samples were RIF resistant by rpoB PCR product sequencing. A 100% concordance (κ value = 1) was obtained between sequencing results derived from bio-safe smear slides and bio-safe sputum. This study demonstrates that Bio-safe method can address safety issues associated with sputum processing, provide an efficient alternative to sample transport in the form of bio-safe stained concentrated smear slides and can also provide information on drug (RIF) resistance by direct DNA sequencing.

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Changing patterns and trends of multidrug-resistant tuberculosis at referral centre in Northern India: A 4-year experience

Abstract: we found a high prevalence (38.8%) of MDR-TB both in new cases (29.1%) and previously treated cases (43.3%).This study strongly highlights the need to make strategies for testing, surveillance, monitoring and management of such drug-resistant cases.

Cited by 20 publications

References 10 publications

Multidrug-resistant pulmonary & extrapulmonary tuberculosis: A 13 years retrospective hospital-based analysis

Multidrug-resistant pulmonary & extrapulmonary tuberculosis: A 13 years retrospective hospital-based analysis

Correlates of Treatment Outcomes and Drug Resistance among Pulmonary Tuberculosis Patients Attending Tertiary Care Hospitals of Kolkata, India

Direct detection of Mycobacterium tuberculosis rifampin resistance in bio-safe stained sputum smears

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