Abstract
BackgroundTuberculosis is a devastating and a deadly disease despite the novel advances in its diagnostic tools and drug therapy. Drug resistant Mycobacterium contributes a great share to tuberculosis mortality. Status of drug resistance and patients’ awareness toward the disease is unknown in northeastern Ethiopia. Thus, the aim of this study was to determine the phenotypic and genotypic drug sensitivity patterns and associated factors in Oromia Special Zone and Dessie Town, northeastern Ethiopia.MethodsIn a cross-sectional study, 384 smear positive tuberculosis cases were recruited and Löwenstein-Jensen culture was done. The performance of GenoTypic MTBDRplus assay using the conventional BACTEC MGIT 960 as a “gold standard” was determined. Drug resistant strains were identified using spoligotyping. Pearson Chi-square test was used to determine the association of drug sensitivity test and tuberculosis type, lineages, dominant strains and clustering of the isolates.ResultsThe 384 smear positive Mycobacterium samples were cultured on LJ media of which 29.2% (112/384) as culture positive. A fair agreement was found between MTBDRplus assay and the conventional MGIT test in detecting the Mycobacterium tuberculosis with sensitivity, specificity, positive and negative predictive value of 94.2, 30.2, 68.4 and 76.5%, respectively. Among LJ culture positive samples 95 of them gave valid result for MTBDRplus assay and 16.8% (16/95) as drug resistant. Similarly, MGIT subculture was made for the 112 isolates and 69 of them gave positive result with 15.9% (11/69) as drug resistant. Cohen’s kappa value showed almost a perfect agreement between the two testing methods in detecting rifampicin (sensitivity 100% and specificity 98.3%) and multi-drug resistance (sensitivity 83.3% and specificity 100%). Spoligotyping identified 76.5% (13/17) of the drug resistant isolates as Euro-American and family 33 as the predominant family. Significant association was observed between drug resistant isolates and the dominant strains (χ2: 34.861; p = 0.040) of the Mycobacterium.ConclusionHigher magnitude of drug resistance was found in the study area. The GenoTypic MDRTBplus assay had an acceptable drug sensitivity testing performance.
Highlights
Tuberculosis is a devastating and a deadly disease despite the novel advances in its diagnostic tools and drug therapy
Antimicrobial susceptibility testing is vital in prescribing an effective drug regime for TB patient, especially in areas where drug resistance incidence is high like Ethiopia
It has a meticulous value in population based studies with low cost to define the phylogeographic specificity of the circulating clades/families of tubercle bacilli. It is the DR region used in individual M. tuberculosis strains and in different members of the M. tuberculosis complex to identify and align the spoligotype patterns. This imply that spoligotyping is recommended as the best preliminary screening test for M. tb isolates that circulates in the societies [7]
Summary
Tuberculosis is a devastating and a deadly disease despite the novel advances in its diagnostic tools and drug therapy. Status of drug resistance and patients’ awareness toward the disease is unknown in northeastern Ethiopia. The cumulative effects of treatment interruption like lack of awareness about the nature of bacteria, shortage and lack of WHOs recommended diagnostic tools, and prolonged drug consumption period for treatment increases the risk. In 2018, an estimated 3.4% of the global TB cases were new drug resistant (MDR/RR) and 18% were among previously treated cases. In Ethiopia, the estimated incidence of MDR/RR is 0.71 and 16% among new and previously treated cases, respectively [3]. The estimated cases of MDR-RR had a magnitude of 484,000 which was about 10% downward from the best estimate published by WHO in its 2018 global TB report. The number of people enrolled in treatment in the year was equivalent to only 32% of the estimated incidence of the 484,000 cases [3, 4]
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