Abstract
Among tuberculosis (TB) patients, acquired resistance to anti-TB drugs represents a failure in the treatment pathway. To improve diagnosis and care for patients with drug-resistant TB, we examined the epidemiology and risk factors associated with acquired drug resistance during 2000–2015 among TB patients in England, Wales, and Northern Ireland. We found acquired resistance in 0.2% (158/67,710) of patients with culture-confirmed TB. Using multivariate logistic regression, we identified the following factors associated with acquired drug resistance: having pulmonary disease; initial resistance to isoniazid, rifampin, or both; a previous TB episode; and being born in China or South Africa. Treatment outcomes were worse for patients with than without acquired resistance. Although acquired resistance is rare in the study area, certain patient groups are at higher risk. Identifying these patients and ensuring that adequate resources are available for treatment may prevent acquisition of resistance, thereby limiting transmission of drug-resistant strains of mycobacteria.
Highlights
In 2015, of an estimated 10.4 million incident tuberculosis (TB) cases worldwide, 4.6% were multidrug resistant (MDR) [1]
Drug-resistant TB can arise in 2 ways: through transmission of a drug-resistant strain or through acquisition of drug resistance [6,7]
In England, Wales, and Northern Ireland, acquiring drug resistance while receiving TB treatment is rare (0.2% of cases) but more likely among those with pulmonary disease; with initial resistance to isoniazid, rifampin, or both; who experienced a previous TB episode; or who were born in China or South Africa
Summary
In 2015, of an estimated 10.4 million incident tuberculosis (TB) cases worldwide, 4.6% were multidrug resistant (MDR) [1]. The main challenges are preventing acquisition of drug resistance and ensuring early detection and appropriate treatment to prevent further transmission of drug-resistant TB. In the Collaborative TB Strategy for England 2015–2020, reducing drug-resistant TB is a key area of action for ensuring that adequate resources needed to prevent and treat MDR TB exist [3]. Acquired drug resistance can result from inadequate treatment, which may be caused by interruptions to receipt of the full drug regimen [8,9]. Our objective for this study was to describe the epidemiology of TB among patients in England, Wales, and Northern Ireland, in whom drug resistance was acquired while they were receiving treatment. We examined the frequency and timing of acquired resistance, sociodemographic and clinical factors associated with acquired resistance, and treatment outcomes for these patients
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