High risk and rapid appearance of multidrug resistance during tuberculosis treatment in Moldova

Abstract

Multidrug-resistant tuberculosis (MDR-TB) is a serious problem in the former Soviet Union and may appear during TB treatment. We aimed to estimate the prevalence of, timing of and factors associated with MDR-TB diagnosis during TB treatment in Moldova, which was part of the former Soviet Union. We analysed data on 3 754 confirmed non-MDR-TB cases (between January 1, 2007 and December 31, 2010) in the Moldovan TB surveillance database, where patients provided sputum specimens for drug-susceptibility testing, multiple times, during treatment. We estimated the percentage of individuals with confirmed baseline non-MDR-TB that were diagnosed with MDR-TB during treatment, documented the time at which MDR-TB was diagnosed, and used a failure-time model to identify factors associated with MDR-TB diagnosis. Between 7.2% and 9.2% of initially non-MDR-TB cases were diagnosed with MDR-TB during treatment. Half of these MDR-TB diagnoses occurred with 3 months of the initial diagnosis. An increased MDR-TB risk during treatment was associated with baseline resistance to first-line TB drugs (linear increase in risk per additional drug), previous incarceration and HIV co-infection. MDR can appear rapidly during TB treatment. Policy considerations should emphasise management during early treatment by increasing ambulatory TB treatment to prevent nosocomial transmission, and ensuring universal rapid diagnostics access to prevent acquisition and transmission of drug resistance.

High rates of multidrug-resistant and rifampicin-resistant tuberculosis among re-treatment cases: where do they come from?

“…Our model does not take into account nosocomial transmission of MDR/RR-TB. While we acknowledge this as a possible cause of MDR/RR-TB presentation at re-treatment [33, 34], insufficient data were available to inform its isolated contribution at the local level. Nevertheless, we can anticipate that our model may underestimate the contribution of reinfection in settings where nosocomial transmission of MDR/RR-TB is significant.…”

The epidemiology, pathogenesis, transmission, diagnosis, and management of multidrug-resistant, extensively drug-resistant, and incurable tuberculosis

“…For example, a study in Moldova found that communities with a larger proportion of previously incarcerated patients with tuberculosis were more likely to be MDR hotspots than communities with fewer of these patients. 29 Similarly, using county-level data from China, another group showed that factors such as health resources, health services, tuberculosis treat ment, and tuberculosis detection, but not socioeconomic status, were associated with drug resistance. 30 …”

Clinical Features and Drug-Resistance Profile of Urinary Tuberculosis in South-Western China

“…Further analysis revealed that drug-resistant patients tended towards unfavorable prognosis compared with drug-susceptible patients. Drug-resistant TB, particularly MDR-TB, was associated with long-term and complicated treatment, poor prognosis, and severe sequels, 17 – 18 , 29 in addition to imposing a tremendous emotional burden on patients and medical workers. 30 Therefore, clinicians should consider the possible diagnosis of drug-resistant TB when UTB patients complain of heavier, retreated disease or delayed healing.…”