Determination of Prevalence and Antimicrobial Resistance Profiles of Mycobacterium tuberculosis Complex Isolates from HIV Positive Patients in Kisumu County, Kenya

Abstract

The purpose of this study was to determine the prevalence and antimicrobial resistance profiles of Mycobacterium tuberculosis complex isolates from HIV positive patients in Kisumu County. This is because the spread of Multidrug-Resistant Tuberculosis (MDR-TB) strains has become a challenge to the global TB control and prevention program. Moreover, researchers from neighboring countries like Ethiopia have reported that despite the existence of MDR-TB strains, very limited information on the strains exist especially among the rural people. A cross-sectional study was conducted between December 2013 and June 2014. The study engaged, 379 HIV positive patients suspected of TB infection who gave sputum samples. The sputum samples were then decontaminated, concentrated, liquefied and neutralized before being cultured in liquid media using Mycobacteria Growth Indicator (MGIT) 960 tubes. The culture positive MGIT tubes were sub cultured in Brain Heart Infusion Agar (BHIA) before microscopic examination of the culture using Ziehl-Neelsen (ZN) smear for Acid Fast Bacilli (AFB), and identified using Genotype MTBC. MGIT 960 tubes positively identified to have Mycobacterium tuberculosis were then subjected to drug sensitivity test using BACTEC 960 susceptibility. This was on the four first line drugs collectively referred to as SIRE (Streptomycin, Isoniazid, Rifampicin and Ethambutol). In the study, 130 (34.3 %) of the 379 suspected TB patients were diagnosed positive for pulmonary TB by MGIT culture. This study also reveals a higher prevalence rate of MDR- TB (18.46 %) among HIV/ TB patients in Kisumu. Further, the study revealed that, the overall resistance to the first line drugs was 6.9% while the individual TB drugs had the following resistance rates; 6.2 % Streptomycin, 10 % Isoniazid, 9.2 % Rifampicin and 3.8 % Ethambutol. Based on the results, the study concludes the following: that Rifampicin and Isoniazid had the high resistance rates 9.2 % and 10 % respectively; the study also reveals a high prevalence rate of MDR-TB (18.46 %) among HIV/TB patients in Kisumu County. Therefore, there is urgent need for the public health sector to incorporate drug susceptibility testing in the management and control of TB so as to detect antimicrobial early and then treated by enhancing capacities of the medical Laboratories in the county. Also, there in need to develop shorter TB drug schedules to enhance adherence to treatment.