Abstract
There are limited data available on the risk factors for multidrug-resistant tuberculosis (MDR-TB). Therefore, we here conducted a retrospective matched case−control study among adults with pulmonary TB who received treatment at the Central Chest Institute of Thailand (CCIT) between January 2007 and December 2013, in order to determine the risk factors associated with MDR-TB among patients with pulmonary TB. We identified 145 patients with pulmonary MDR-TB (cases) and 145 patients with drug-sensitive pulmonary TB (controls). Multivariate analysis identified the independent risk factors for MDR-TB as follows: (1) ≥ 2 episodes of prior pulmonary TB (odds ratio [OR] 39.72, 95% confidence interval (95% CI) 7.86−200.66), (2) duration of illness > 60 days (OR 3.08, 95% CI 1.52−6.22), (3) sputum acid fast bacilli smear 3+ (OR 13.09, 95% CI 4.64−36.91), (4) presence of lung cavities (OR 3.82, 95% CI 1.89−7.73), and (5) presence of pleural effusion (OR 2.75, 95% CI 1.06−7.16). Prior pulmonary TB management with a non-category I regimen (P = 0.012) and having treatment failure or default as treatment outcomes (P = 0.036) were observed in a higher proportion among patients with MDR-TB. Particular characteristics of lung cavities, including the maximum diameter ≥ 30 mm (P < 0.001), the number of cavities ≥ 3 (P = 0.001), bilateral involvement (P < 0.001), and ≥ 2 lung zones involved (P = 0.001) were more commonly observed in patients with MDR-TB. In conclusion, these clinical factors and chest radiographic findings associated with MDR-TB among patients with pulmonary TB may help physicians to provide proper management of cases for prevention of the development and spread of MDR-TB in future.
Highlights
Tuberculosis (TB) is caused by Mycobacterium tuberculosis and remains one of the leading causes of death worldwide, despite the availability of effective anti-TB drugs [1]
Of 558 patients with pulmonary multidrug-resistant tuberculosis (MDR-TB), 145 patients fulfilled the study criteria; 413 patients were excluded as follows: 33 patients had mixed infection with non-TB mycobacteria, 42 patients were < 18 years, 54 patients had no available drug-susceptibility testing (DST) results from the microbiology laboratory records of the central laboratory at the Central Chest Institute of Thailand (CCIT), 69 patients had no available chest radiographs or had chest radiographs of limited quality, 96 patients had negative sputum acid-fast bacilli (AFB) smears or sputum showing no growth of M. tuberculosis upon culture as based on the microbiology laboratory records of the central laboratory at the CCIT, and 119 patients had no available documentation on the diagnosis and management of previous pulmonary TB and/or present pulmonary TB
A total of 290 pulmonary TB patients who received treatment at the CCIT were recruited into the study; 145 were pulmonary TB patients with MDR-TB, defined as cases, and 145 were pulmonary TB patients with drug-sensitive TB, defined as controls (Fig 1)
Summary
Tuberculosis (TB) is caused by Mycobacterium tuberculosis and remains one of the leading causes of death worldwide, despite the availability of effective anti-TB drugs [1]. The majority of TB patients (80.0%) had pulmonary TB with a treatment success rate of 81% among new or relapse cases; MDR-TB developed in 19.0% of previously treated patients, but in only 2.0% of newly diagnosed TB patients [2]. The majority of patients with pulmonary MDR-TB were referred to the CCIT for treatment when the physician suspected MDR-TB or when the sputum culture isolates of M. tuberculosis showed a drug-resistant strain. Chest radiography is a simple diagnostic tool and usually helps physicians to identify and manage pulmonary TB when the results of culture and DST are not yet available. No previous report has attempted to identify risk factors from among clinical factors, microbiology data, and chest radiographic findings in pulmonary MDR-TB in Thailand.
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