Abstract
The aim of this study was to estimate the prevalence, possible risk factors, patterns of resistance, and fate of multidrug-resistant pulmonary tuberculosis (MDR-TB) in Alexandria governorate as a representative part of Egypt during the period between July 2008 and December 2012. This retrospective study included all patients with pulmonary TB that was recorded in Alexandria governorate during the period between July 2008 (the time that MDR ward was held in Alexandria) and December 2012. They were divided into two groups: group I included patients with pulmonary TB that was recorded in Alexandria governorate (1893 cases), and group II included patients with pulmonary TB who were admitted in El-Maamoura Chest Hospital (509 cases). They were subdivided into two subgroups: group IIa included patients with MDR pulmonary TB (82 cases), and group IIb included patients with pulmonary TB not categorized as MDR-TB (427 cases). All patients with MDR-TB had acquired resistance. MDR-TB was more common in the male population, diabetic patients, and those with chronic chest disease. The effect of treatment of MDR-TB cases was as follows: cured patients, 49 (59.8%); patients under treatment, 10 (12.2%); treatment failure, four cases (4.9%); deceased patients, 10 (12.2%); and defaulters, nine (10.9%). The overall total prevalence rate of MDR-TB in Alexandria governorate from 2008 to 2012 was 4.3%. There was a decreasing trend of MDR-TB cases. History of anti-TB treatment is the strongest independent predictor of MDR-TB. The highest figures of resistance in the MDR group besides isoniazide and rifampicin were for streptomycin, whereas the lowest resistance was for ethambutol.
Highlights
Strains of Mycobacterium tuberculosis that are resistant to both isoniazid and rifampicin with or without resistance to other drugs have been termed multidrug-resistant (MDR) strains
Multidrug-resistant tuberculosis (MDR‐TB) is caused by the transmission of MDR M. tuberculosis strains in new cases, or by the selection of single-drug-resistant strains induced by previous treatments [2]
The incidence of drug resistance has increased since the first drug treatment for TB was introduced in 1943.The emergence of multidrug-resistant pulmonary tuberculosis (MDR-TB) followed the widespread use of rifampicin since the 1970s [3]
Summary
Strains of Mycobacterium tuberculosis that are resistant to both isoniazid and rifampicin with or without resistance to other drugs have been termed multidrug-resistant (MDR) strains. The incidence of drug resistance has increased since the first drug treatment for TB was introduced in 1943.The emergence of MDR-TB followed the widespread use of rifampicin since the 1970s [3]. The spectrum of this form of TB ranges from ‘basic’ MDR-TB, with resistance only to rifampicin and isoniazid, to XDR-TB, which has additional extensive drug resistance to at least three of the six main classes of second-line antiTB drugs [4]. Alexandria governorate is one of the governorates of Egypt It is located in the northern part of the country, directly on the Mediterranean Sea, making it one of the most important harbors in Egypt
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