Drug resistance among tuberculosis patients attending diagnostic and treatment centres in Makassar, Indonesia

Abstract

Government tuberculosis (TB) diagnostic and treatment centres, Makassar, Indonesia. To determine the proportions and patterns of resistance to commonly used TB drugs (isoniazid [INH], rifampicin, ethambutol and streptomycin) among pulmonary TB patients and assess potential risk factors for drug resistance. Cross-sectional study. Of 657 recruited patients, 234 were culture-positive. Drug susceptibility testing (DST) results were available for 216 patients. Among these, 197 were infected with Mycobacterium tuberculosis complex (145 new and 52 previously treated). Isolates from 89 new (61.4%) and 31 previously treated (59.6%) patients were susceptible to all four drugs. Resistance to INH was high among both patient groups (28.3% of new vs. 34.6% of previously treated). Multidrug-resistant TB (MDR-TB) cases accounted for respectively 4.1% and 19.2% of these patients. Resistance to >2 drugs was high among previously treated patients (19.2%). MDR-TB cases were more likely to have a history of excess alcohol use (adjusted OR 4.01, 95%CI 1.28-12.53) and previous TB treatment (adjusted OR 6.28, 95%CI 2.01-19.64). Regardless of previous treatment history, many culture-positive TB patients were infected with INH-resistant isolates, and a significant proportion of previously treated patients were infected with MDR-TB. Treating culture-positive TB patients, especially previously treated patients, based on DST results should therefore be considered.