Incidence Density and Predictors of Multidrug-Resistant Tuberculosis Among Individuals With Previous Tuberculosis History: A 15-Year Retrospective Cohort Study

Abstract

Background: To date, too little attention has been paid to monitoring and estimating the risk of incident multidrug-resistant tuberculosis (MDR-TB) among individuals with a previous tuberculosis history (PTBH). The purpose of this study was to assess the incidence of and risk factors for MDR-TB in those individuals.Methods: Between 2005 and 2020, a large, retrospective, population-based cohort study was performed in Hangzhou, China. A multivariable Cox regression model was used to evaluate independent predictors of incident MDR-TB among individuals with PTBH.Results: The incidence density of MDR-TB was 22.6 per 1,000 person-years (95% confidence level and an interval of 20.9–24.3) for individuals with PTBH. The incidence of MDR-TB increased significantly in individuals who• were under 60 years old.• were male.• had a history of direct contact.• came from low-income families.• worked in high-risk occupations.• lived in rural areas.• had a retreatment TB history.• had an unfavorable outcome in their previous treatment (P < 0.05).In addition, we found that the following factors were significantly linked to the MDR-TB risk among individuals with PTBH (P < 0.05):• sociodemographic factors such as the 21–30 and 31–40 year age groups, or a history of direct contact.• clinical factors like passive modes of TB case finding (PMTCF), human immunodeficiency virus infection, unfavorable treatment outcomes, retreated TB history, non-standardized treatment regimens of retreatment TB patients, and duration of pulmonary cavities (DPC).• microbiological factors, such as duration of positive sputum culture.We also found that the 21–30 year age group, low family income, and PMTCF were significantly linked to incident MDR-TB only in males with PTBH, whilst the 41–50 year age group, extended treatment course, and DPC were significantly associated with female MDR-TB only.Conclusion: The incidence of MDR-TB was high, with a higher rate among subjects with a history of direct contact and unfavorable treatment outcomes. There was a gender difference in the incidence density and risk factors of MDR-TB among individuals with PTBH. Long-term monitoring and gender-specific risk-factor modifications should be given to individuals with PTBH.

Proportion of Extrapulmonary MDR-TB Confirmed by GeneXpert® in Dr. Hasan Sadikin General Hospital, West Java, Indonesia Year 2012–2021

“…Those numbers might differ from other studies in other countries. 5,31 Primary MDR-TB patients took over 11% of MDR-TB patients and were found in six out of 17 extrapulmonary MDR-TB patients, similar to the result in a study done in India (7.9%). 32 Yet, Indonesia and India also had similar estimated percentages in primary MDR-TB incidence, consecutively 2.4% and 2.8%.…”

Comparison of Anxiety Levels in MDR-TB Patients with Individual and Short-term Regimens at Dr. Soebandi Regional General Hospital, Jember, Indonesia

“…10 The productive age group plays a significant role in the spread of MDR-TB as the stigma surrounding MDR-TB may hinder the economic activities of patients, leading to a delay in seeking treatment. 11 These results align with the study by Imam, et al (2023), which stated that individuals in the productive age group are highly vulnerable to MDR-TB due to increased social interaction and mobility. 12 Most of the samples in this study have completed primary and junior high school education.…”