Abstract
Drug-resistant tuberculosis (TB) poses a major public health concern worldwide. However, no studies have addressed risk factors for drug resistance in Ontario, which has its own unique profile of immigrants. We evaluated demographic and clinical risk factors for drug-resistant TB among patients treated at West Park Healthcare Centre, located in Toronto, Ontario (Canada). All patients who were diagnosed with TB and treated at West Park Healthcare Centre between January 2010 and December 2016 were included in this retrospective cohort study. Characteristics of patients with isoniazid mono-resistant (INH-R) TB and multidrug resistant (MDR) TB were compared to patients with drug-susceptible TB with bivariate and multivariable logistic regression. Risk factors for INH-R TB included younger age (younger than 35 years), prior TB treatment, non-diabetic and birth in a non-South-East Asian country, but only the latter two factors were significant in multivariable analysis. On the other hand, we found younger generation (younger than 65 years), birth in European region, recent arrival to Canada (fewer than 120 months), prior treatment and human immunodeficiency virus (HIV) infection were associated with MDR-TB, among which younger age (younger than 35 years), more recent immigration (fewer than 24 months), prior treatment and HIV infection were significant in multivariable analysis. These findings may be of use to TB clinicians in the province by informing the initial empiric antibiotic regimen prescribed while awaiting phenotypic drug susceptibility testing and assisting in decisions regarding whether to request rapid molecular drug susceptibility testing.
Highlights
Drug-resistant tuberculosis (TB) poses a major public health concern worldwide
These findings may be of use to TB clinicians in the province by informing the initial empiric antibiotic regimen prescribed while awaiting phenotypic drug susceptibility testing and assisting in decisions regarding whether to request rapid molecular drug susceptibility testing
The other 83 patients (17.1%) did not have a phenotypic drug susceptibility testing (DST) performed in Ontario, and were excluded from further risk factor analyses
Summary
Drug-resistant tuberculosis (TB) poses a major public health concern worldwide. The two most common, clinically important forms of drug-resistant TB include isoniazid (INH) mono‐resistant (INH-R) (resistant to INH) and multidrug-resistant (MDR) TB (resistant to at least INH and rifampin, RMP) [1,2]. Drug resistance is identified either by genotypic methods or phenotypic culture-based drug susceptibility testing (DST), the latter being considered the gold standard [3]. Phenotypic DST can take weeks to report, and not all clinical settings perform rapid molecular DST routinely. Clinicians often start empiric TB treatment prior to the availability of phenotypic DST results, and may expand the initial empiric regimen, or may request rapid molecular DST, based upon an individual patient’s risk factors for drug resistance. Drug-resistant tuberculosis (TB) poses a major public health concern worldwide. No studies have addressed risk factors for drug resistance in Ontario, which has its own unique profile of immigrants. We evaluated demographic and clinical risk factors for drug-resistant TB among patients treated at West Park Healthcare Centre, located in Toronto, Ontario (Canada)
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