Predisposing factors for multi drug resistant Tuberculosis in Southest Region of Turkey

Abstract

Drug resistance (DR) is an important problem in tuberculosis (TB) control programs. This study investigated the university hospital records of TB patients, along with the drug resistance ratios, the risk factors for developing multi drug resistance and their effects. Multi drug resistance is defined as the presence of both isoniazid (H) and rifampicin (R) resistance. The records of TB patients who had been diagnosed between January 2002 and December 2011 were evaluated retrospectively. Multi drug resistance was determined in 59 patients. The control group included 127 patients whose antibiograms had shown susceptibility to H, R, ethambutol (E) and streptomycin(S) (drug susceptible: DS) or who were resistant to one or more of these drugs, but not to both H and R simultaneously (mono resistant: MR). We randomly selected these 127 patients from 600 cases of TB that had been recorded through laboratory culture antibiogram data. There were no differences in age, gender, marital status or TB type between the multidrugresistant (MDR) and the control group, nor for the presence of cavities on their chest radiographies or smear positivity (p<0.05). The study found a significantly increased risk of multi drug resistance among those with poor socioeconomic status, at 7.17 times higher (2.61-19.67), and those with a previous history of TB, at 5.61 times higher (2.10-15.07), as well as in patients who had diabetes mellitus, at 3.68 higher (1.15-11.79), in logistic regression analysis. Determining the risk factors for developing multi drug resistance in TB patients is critical in order to be able to prioritize the interventions to address this drug resistance. Although many risk factors for MDR TB have been reported, the most important appear to be a previous history of TB, previously administered TB treatment and inappropriate TB treatment.