Multidrug-Resistant Tuberculosis in Admitted Patients at a Tertiary Referral Hospital of Bangladesh

Abstract

Background This study was set out to investigate the magnitude, patterns and molecular characterization of drug-resistant Mycobacterium tuberculosis strains at a tertiary referral hospital in Bangladesh. Methods Pulmonary tuberculosis (TB) patients admitted at National Institute of Diseases of the Chest and Hospital from February 2002 to September 2005 with or without previous history of TB and/or other complications were randomly interviewed. Among 265 participants enrolled, M. tuberculosis isolates from 189 patients were finally tested for susceptibility to rifampicin (RMP), isoniazid (INH), ethambutol (ETM) and streptomycin (STM). Genotyping of M. tuberculosis was done using deletion analysis and spoligotyping. Results Eighty-eight percent (n = 167) of the patients had history of previous anti-TB treatment while the remaining 12% were new TB cases. Of the 189 isolates, 9% were fully susceptible to the first line anti-TB drugs and 73.5% were multi-drug resistant TB. Other susceptibility results showed 79.4%, 77.2%, 76.7% and 78.8% resistance to INH, RMP, ETM and STM respectively. Multi-drug resistance was significantly higher among the 130 (78%) patients with previous history of anti-tuberculosis treatment (95% confidence interval, p = 0.001). Among the 189 analyzed isolates, 69% were classified as “modern” M. tuberculosis strains (i.e. TbD1- strains, lacking the M. tuberculosis -deletion region TbD1), whereas the remaining 31% were found to belong to the “ancestal” TbD1+ M. tuberculosis lineages. One hundred and five different spoligotype patterns were identified in which 16 clusters contained 100 strains and 89 strains had unique pattern. Strains with a spoligotype characteristic for the “Beijing” cluster were predominant (19%) and most of these strains (75%) were multi-drug resistant (MDR). Conclusions A high level of drug resistance observed among the re-treatment patients poses a threat of transmission of resistant strains to susceptible persons in the community. Proper counseling of patients and attention towards the completion of the anti-TB treatment is needed.

Drug resistance pattern, related socio- demographic factors and preventive practices among MDR-TB patients: An experience from a tertiary care setting

“…Al-hajoj et al 14 found multi drug resistance in 1.8 % and 15.9% of new and pre-treated cases of TB respectively in a study in Saudi Arabia and that presence of pulmonary TB, active TB were strongest independent contributors. Similar results were reported from Rawalpindi, Pakistan by Khurram et al 9 , and from Bangladesh by Banu et al 15 who showed MDR significantly increase in those previously treated or defaulters. In Ethiopia, Abate G 16 Showed MDR prevalence were more in retreatment cases (12%) than new (1.2%).…”

FAST implementation in Bangladesh: high frequency of unsuspected tuberculosis justifies challenges of scale-up

“…Patients with unsuspected TB were more than five times as likely to be diagnosed with MDR-TB than those admitted with a known TB diagnosis (OR 4.9, p<0.001), highlighting the importance of rapid molecular drug susceptibility testing for all patients being evaluated for TB. The reason for the lower rate of MDR-TB (6.3%) demonstrated here in comparison to other studies at NIDCH that demonstrated higher rates of MDR-TB patients (>60%) 17,18 is unclear, although those studies only evaluated smear positive patients and one specifically evaluated patients with risk factors for MDR-TB 17 .…”

Delay in Diagnosis of Tuberculosis among Under Treatment Patients in Rajshahi City, Bangladesh

“…2 TB remains a one of the major causes of morbidity and mortality in Bangladesh. Bangladesh is placed 6 th among the 22 TB high burden countries (HBCs) 3 which focuses the susceptibility of TB in the country. From 1993 onwards, the estimated case detection rate of the NTP has remained below the target of World Health organization (WHO) and diagnostic delay is one of the significant reasons behind this.…”