Abstract
BackgroundThe spread of multidrug-resistant tuberculosis (MDR-TB) strains has become a challenge to the global TB control and prevention program. In Ethiopia, particularly in rural areas, information on drug-resistant TB is very limited. In this study, we determined the drug resistance patterns of Mycobacterium tuberculosis (M. tuberculosis) isolates from pulmonary TB patients attending two public hospitals in the East Gojjam zone of northwest Ethiopia.MethodsA cross-sectional study was conducted between May 2011 and January 2012 using Region of difference-9 (RD9) typing for the identification of species mycobacterium. Drug susceptibility testing (DST) of M. tuberculosis isolates to the first-line drugs: isoniazid, rifampicin, ethambutol and streptomycin was performed by the indirect proportion method on Middle brook 7H10 Agar media.ResultsOut of 385 pulmonary TB suspects studied, 124 (32.2 %) were culture positive among which 120 were M. tuberculosis strains. Susceptibility testing was performed for 89 isolates. Resistance to at least one drug was 15.58 % ([12/77], 95 % CI: 7.48-23.68) among newly diagnosed and 50.0 % ([6/12], 95 % CI: 21.71-78.29) among previously treated cases. Resistance among newly diagnosed patients was most common for streptomycin 5.19 % (4/77) and ethambutol 5.19 % (4/77) followed by rifampicin 3.89 % (3/77). Among retreatment cases, isoniazid resistance was most frequent in which 33.33 % (4/12) of the isolates were resistant. MDR prevalence was 1.29 % (1/77) for newly diagnosed and 16.67 % (2/12) for retreatment cases. In a multivariate logistic regression analysis, age group of 25–34 years (adjusted OR = 4.24; 95 % CI: 1.02-17.5; P = 0.046) and previous history of treatment (adjusted OR = 5.42; 95 % CI: 1.56-27.49; P = 0.01) were independently associated with anti-TB drug resistance.ConclusionsIn general, the magnitude of anti-TB drug resistance including MDR-TB was comparable to previous studies in other areas of Ethiopia. However, rifampicin resistance was high, which could suggest the potential for a rise in the incidence of MDR. Therefore, re-enforcing TB control programs should be considered by the concerned public health authorities.
Highlights
The spread of multidrug-resistant tuberculosis (MDR-TB) strains has become a challenge to the global TB control and prevention program
In countries with high burden of TB, continuous surveillance and regular monitoring of drug resistance based on routine drug susceptibility testing (DST) of TB patients is essential to assess the magnitude and trends of anti-TB drug resistance [1, 2]
In Ethiopia, there is limited capacity to perform culture and Drug susceptibility testing (DST) of M. tuberculosis, even from patients suspected of harbouring drug-resistant strains
Summary
The spread of multidrug-resistant tuberculosis (MDR-TB) strains has become a challenge to the global TB control and prevention program. In Ethiopia, in rural areas, information on drug-resistant TB is very limited. We determined the drug resistance patterns of Mycobacterium tuberculosis (M. tuberculosis) isolates from pulmonary TB patients attending two public hospitals in the East Gojjam zone of northwest Ethiopia. The emergence of drug-resistant tuberculosis is a critical threat to tuberculosis (TB) control and is a major public health concern in several countries. Multidrug-resistant TB (MDR-TB), defined as resistant to at least isoniazid and rifampicin, is emerging as a major clinical and public health challenge in areas of sub-Saharan Africa [1]. In Ethiopia, there is limited capacity to perform culture and DST of M. tuberculosis, even from patients suspected of harbouring drug-resistant strains. Many of MDR-TB patients remain undiagnosed which negatively impacts the global strategy of halting and eliminating TB [3]
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