Rates of drug resistance and risk factor analysis in civilian and prison patients with tuberculosis in Samara Region, Russia

Abstract

Background: Tuberculosis (TB) and HIV rates continue to escalate in Russia, but true rates for drug resistance, especially multidrug resistant tuberculosis (MDR TB), are unknown. A study was conducted with the aims of identifying first line drug resistance, both in the civilian and prison sectors, for new and previously treated cases; and risk factors for the development of drug resistance. Methods: A cross sectional survey was undertaken of 600 patients (309 civilians, 291 prisoners) with bacteriologically confirmed pulmonary TB over a 1 year period during 2001-2 in Samara Oblast, Russia. Results: The prevalence of isoniazid, rifampicin, streptomycin, ethambutol and pyrazinamide resistance in new TB cases (civilian and prison patients) was 38.0%, 25.2%, 34.6%, 14.7%, and 7.2%, respectively. The prevalence of MDR TB was 22.7%, 19.8%, and 37.3% in all new cases, new civilian cases, and new prison cases, respectively, with an overall prevalence of 45.5% and 55.3% in previously treated cases. Factors associated with resistance included previous TB treatment for more than 4 weeks, smoking (for isoniazid resistance), the presence of cavitations on the chest radiograph, and imprisonment. HIV was not associated with resistance in all patients. The rates of resistance were significantly higher in prisoners, with rate ratios (RR) of 1.9 (95% CI 1.1 to 3.2) for MDR TB, 1.9 (95% CI 1.1 to 3.2) for rifampicin, and 1.6 (95% CI 1.0 to 2.6) for isoniazid. Conclusions: Rates of first line drug resistance are high, particularly in prisoners and previously treated cases. TB control programmes should initially focus on standardised treatment to maximise cure, combined with measures to reduce institutional TB spread (particularly in prisons) coupled with early diagnosis of MDR TB to reduce the spread and development of resistance.

Extremely high prevalence of multidrug resistant tuberculosis in Murmansk, Russia: a population-based study

“…The SIT1 spoligotype is characteristic of the Beijing/W family, which is known for its frequent association with MDR, outbreaks and high emergence worldwide. The prevalence of Beijing isolates in Russia, both in prisons and in the community, and the high rate of MDR typical for this group have been recognized in a number of studies [5,6,23,[25][26][27]. Our results are consistent with this observation and demonstrate that the Beijing genotype plays an important role in the epidemiology of MDR-TB in civilian population of this high incidence region of the North-Western Russia.…”

Multidrug-resistant tuberculosis in Belarus: the size of the problem and associated risk factors

“…32 Patients with a history of imprisonment were also found to have a significantly increased risk of MDR-TB, as reported in three previous studies. 26,33,34 Finally, self-reported disability that was severe enough to prevent work was also positively associated with MDR-TB. However, this apparent association may be an artefact produced by the social security system in Belarus, which categorizes those who are receiving extended treatment for MDR-TB as disabled.…”

Risk factors of Multidrug Resistant Tuberculosis in central Nepal: A pilot study

“…In Nepal, levels of drug resistance are very high, with nearly 14.7% of new patients resistant to at least one drug 2 Previous treatment of tuberculosis has been consistently reported as the risk factor within various clinical conditions and populations. [4][5][6][7][8][9][10] The present study also revealed that previous treatment of tuberculosis was strongly associated with MDR TB OR =2.799 (95 % CI 1.159 to 6.667) (p=0.020).According to the National Tuberculosis Programme's Nepal National Survey in 2007, MDR among new cases of TB is 2.9% and MDR among previously treated cases is at 11% thereby giving a ratio of approximately 4:1 for prevalence of MDR in these groups, 2 this pattern holds true in our study too. Lomtadze et.…”