Risk Factors For Multidrug-resistant Tuberculosis Research Articles

Drug resistance in drug-resistant tuberculosis patients with and without diabetes mellitus: a comparative analysis

BackgroundThis dual burden of tuberculosis (TB) and diabetes mellitus (DM) has become a global public health concern. This study aims to compare drug resistance in drug-resistant tuberculosis (DR-TB) patients with and without DM and analyse the risk factors of multidrug-resistant tuberculosis (MDR-TB).MethodsA total of 893 DR-TB patients were admitted to Wenzhou Central Hospital between January 2018 and December 2022. After excluding 178 cases with incomplete clinical and laboratory data, 715 patients were included in the study. These patients were then categorized into two groups based on the presence of type 2 DM: the DM group (160 cases) and the non-DM group (555 cases). Demographic information, baseline clinical characteristics, laboratory and imaging test results, clinical diagnoses, and other relevant data were collected for analysis. Statistical analysis was conducted on demographic information, clinical parameters, drug resistance spectrum, and risk factors for multidrug resistance.ResultsIn both the DM and non-DM groups, the order of resistance to first-line anti-tuberculosis drugs is isoniazid, streptomycin, rifampicin, and ethambutol. There is no significant difference in the proportion of mono-resistant tuberculosis, polydrug-resistant tuberculosis, and multidrug-resistant tuberculosis between the two groups (P > 0.05). The prevalence of MDR-TB in both groups shows a downward trend between 2018 and 2022, but the trend is not statistically significant (P > 0.05). Among patients without DM, residence in rural areas, retreatment of tuberculosis, pulmonary cavity, and uric acid ≥ 346 µmol/L are identified as independent risk factors for MDR-TB. Among patients with DM, residence in rural areas, retreatment of tuberculosis, pulmonary cavity, and HbA1c ≥ 9.8% were identified as independent risk factors for MDR-TB.ConclusionIsoniazid is the most resistant drug among DR-TB patients with and without DM. There is no statistically significant difference in drug resistance patterns between the two groups. Some progress has been made in the prevention and control of DR-TB in this area, but the effect is not very significant. There are differences in the risk factors of MDR-TB between patients with and without DM.

Modelling Time to Recovery from Multidrug Resistant Tuberculosis in Southern Ethiopia

Introduction: Multidrug resistant tuberculosis (MDR-TB) is a global heath threat, resistant to key anti-TB drugs. It is ranked among the top 10 causes of death worldwide. Therefore, the current study investigated time to recovery from MDR-TB in southern Ethiopia. Data, Materials and Methods: Restrospective data from selected hospitals in SNNPR (January 2016 to December 2021) were analyzed. A cluster sample of 301 MDR-TB patients (131 NEMMCH, 121 BH, 49 AGH) was considered. Results: Among the 301 cases, 116 (38.5%) were censored. While 185 (61.5%) were recovered. Parametric shared frailty models were employed to account unobserved heterogeneity among the Hospitals and patients and AFT models were employed. the median recovery time of MDR-TB is 22 months. The clustering effect of frailty model was hospitals. Weibull-gamma shared frailty model was appropriate for this data. Conclusion: The final model showed that males have higher recovery rates than females. Extra pulmonary MDR-TB and Urban residency correleted with longer recovery times. The recovery rate increases with increasing baseline weight, education level, and occupation. But, the recovery rate decreases with smoking, co-morbidities, previous drug history, history of TB, and alcohol use Recommendation: All concerned bodies should be cognizant on the risk factors of MDR-TB in SNNP region By providing on early case detection and appropriate treatment of drug-susceptible MDR-TB, since it is essential to shorten the recovery time of MDR-TB patients in line with WHO guidelines

Risk factors for multidrug-resistant tuberculosis: a predictive model study.

To investigate the risk factors associated with Multidrug-resistant tuberculosis (MDR-TB) in people with drug-resistant tuberculosis (DR-TB) and develop a predictive model. A total of 893 individuals with DR-TB treated at Wenzhou Central Hospital from January 2018 to December 2022 were included in the study after excluding 178 individuals with incomplete clinical and laboratory data, leaving 715 individuals for analysis. Data on demographic information, baseline clinical characteristics, laboratory and imaging results, and clinical diagnosis were collected to identify the risk factors for MDR-TB and establish a predictive model. Multivariate logistic regression analysis identified residence in rural areas, retreatment of TB, presence of pulmonary cavity, uric acid (UA) ≥ 346 μmol/L and c-reactive protein (CRP) < 37.3 mg/L as independent risk factors for MDR-TB in individuals with DR-TB. A nomogram model was constructed using these five factors to predict the risk of MDR-TB, with an area under the ROC curve (AUC) of 0.758 for the training group and 0.775 for the validation group. Calibration curve analysis showed good agreement between predicted and actual MDR-TB incidence in both groups, and decision curve analysis showed that the nomogram model had a higher rate of clinical net benefit. This study suggests that residence, types of TB treatment, presence of pulmonary cavity, UA and CRP are associated with MDR-TB occurrence in individuals with DR-TB, and the nomogram model developed in this study shows promising predictive value.

Prevalence and risk factors of multidrug-resistant tuberculosis in Jazan, Saudi Arabia

Abstract Background Drug-resistant tuberculosis (DR-TB) is a global challenge. Owing to its high annual mortality and morbidity rates, as stated in the annual global TB reports provided by WHO, the prevalence of multidrug-resistant tuberculosis (MDR-TB) or rifampicin-resistant tuberculosis was shown to be increasing worldwide in 2021. Patients with tuberculosis from 2018 to 2022 represented ~40 million individuals, including 1.5 million with DR-TB. The study’s goal was to identify MDR-TB prevalence and risk factors in Jazan, Saudi Arabia. Patients and methods The research was done on 114 patients diagnosed with pulmonary TB in Jazan Chest Hospital from January to April, 2019. Demographic data were collected. Monteux test, chest radiograph, sputum smear, and Lowenstein–Jensen culture were performed for all patients with pulmonary TB. Patients were allocated in either group A, with 103 (90.4%) patients, if they had Mycobacterium tuberculosis-susceptible isolates, or in group B, with 11 (9.7%) patients, if they had M. tuberculosis-resistant isolates. Results The observed overall DR-TB prevalence was 9.7%. The proportion of MDR isolates was 7%, polyresistant isolate TB was 0.9%, rifampicin-resistant tuberculosis was 0.9%, and ethambutol-resistant TB was 0.9%. Females were more in group B (54.5%) than in group A (26.2%). Unmarried patients were higher in group A (60.2%) than in group B (29.3%). Comorbidities had significant values in the drug-resistant groups (90.9%). Conclusion The study showed that screening and treatment of DR-TB are crucial for the control of TB in Jazan and Saudi Arabia as a whole.

Risk factors for multidrug-resistant tuberculosis in the Central African Republic: A case-control study

BackgroundThe emergence and spread of multidrug-resistant tuberculosis (MDR-TB) presents a challenge to the "End TB by 2035" strategy. This study aimed to identify the risk factors associated with MDR-TB in patients admitted to the pneumo-physiology clinic of the National University Hospital of Bangui in Central African Republic. MethodsThis was a “retrospective” chart review study. Cases were represented by patients more than 18 years of age treated for MDR-TB and controls were patients with “at least rifampicin-susceptible” TB treated "with first-line anti-TB regimen" and who at the end of treatment were declared cured. The status of “cured” was exclusively applicable to non-MDR TB. Risk factors associated with MDR-TB were identified by multivariate analysis. ResultsWe included 70 cases and 140 controls. The median age was 35 years, IQR (22;46 years). The main factors associated with the occurrence of MDR-TB in multivariate analysis were male gender (0 R = 3.02 [1.89–3.99], p = 0.001), residence in a peri-urban/urban area (0 R = 3.06 [2.21–4.01], p = 0.002), history of previous TB treatment (0 R= 3.99 [2.77–4.25], p < 0.001) and the presence of multidrug-resistant TB in the family (0 R=1.86 [1.27–2.45], p = 0.021). ConclusionThe emergence of MDR-TB can be reduced by implementing appropriate strategies, such as preventive therapy in contacts of MDR-TB patients and detecting and appropriately treating MDR-TB patients to prevent further spread of infection.

Epidemiological characteristics and risk factors of multidrug-resistant tuberculosis in Luoyang, China.

We aimed to examine the prevalence of multidrug-resistant tuberculosis (MDR-TB) in Luoyang, China, identify related risk factors, inform clinical practices, and establish standardized anti-tubercular treatment regimens. We conducted a retrospective analysis of high-resolution melting curve (HRM) data from 17,773 cases (2,748 of which were positive) between June 2019 and May 2022 to assess the prevalence of MDR-TB and to identify its associated risk factors. Between June 2019 and May 2022, out of the 17,773 HRM results, 2,748 were HRM-positive, and 312 were MDR-TB cases. The detection rates for HRM-positive and MDR-TB were 17.0 and 12.1% for males, and 12.4 and 8.2% for females, respectively. The MDR-TB detection rate was higher in the urban areas (14.6%) than in the rural areas (10.6%) and more common among individuals under 51 years of age (14.1%) than those over 50 years of age (9.3%). Notably, the rate of detecting MDR-TB was 18.3% higher in new male patients than in new female patients, which was at 10.6%, and this difference was statistically significant (p < 0.001). Moreover, the rate of MDR detection in females who had received anti-tuberculosis treatment (21.3%) was higher than that in males (16.9%). In the multivariate model that considered the results of the sputum smear and detection time, MDR-TB was positively correlated with a history of tuberculosis (TB) treatment, being male, being younger than 51 years, and living in urban areas. Local TB infections are complex and diverse; therefore, more comprehensive monitoring methods are needed to curb the spread of MDR-TB.

An analysis of risk factors for Multidrug Resistant Tuberculosis (MDR-TB): a hospital-based study

Multidrug Resistant Tuberculosis (MDR-TB) is the world's most serious problem and one of the leading causes of death. Because of its difficult diagnosis, high rates of treatment failure, and death, MDR-TB is a new challenge in TB control programs. The study aims to identify and analyze the risk factors of Multidrug Resistant Tuberculosis (MDR-TB). The study used a case control study design and was conducted at the Labuang Baji Hospital in Makassar City, Indonesia. The sample was 140 people consisting of 70 in the case group and 70 in the control group. Purposive sampling was used to collect the data. Data were analyzed using STATA program with Multiple Logistic Regression. Significant risk factors of Multidrug Resistant Tuberculosis (MDR-TB) were duration of treatment (OR= 5.655 [Cl 95%: 2.507-12.999]; p&lt;0.001), previous treatment history (OR= 4.833 [Cl 95%: 2.092-11.525]; p&lt;0.001), PMO factor (OR= 3.106 [Cl 95%: 1.227-8.338]; p=0.008), compliance with drugs (OR= 10.961 [Cl 95%: 4.640-26.40]; p&lt;0.001), drug side effects (OR=2.521 [Cl 95%: 1.070-6.126]; p=0.020) and protective factor is the complexity of drug regimen (OR= 0.329 [Cl 95%: 0.136-0.768]; p=0.005). It can be concluded that compliance with drugs is a dominant risk factor for MDR-TB. Improved TB control programs by monitoring the treatment of patients who experienced treatment failure (dropout) probably will increase treatment adherence and cut off MDR-TB transmission.

The differences in drug resistance between drug-resistant tuberculosis patients with and without diabetes mellitus in northeast China: a retrospective study

BackgroundDiabetes mellitus (DM) and drug-resistant tuberculosis (DR-TB) are serious global public health problems. This study aimed to explore the differences in drug resistance between DR-TB patients with and without DM. Risk factors for developing multidrug-resistant tuberculosis (MDR-TB) were also investigated among DR-TB patients.MethodsThe patient’s basic demographic, clinical characteristics, and drug susceptibility testing (DST) data were collected from the Chinese Disease Control Information System. Descriptive statistics were used to estimate the frequency and proportion of included variables. Categorical variables were compared using the Chi-square test or Fisher’s exact test. Chi-square tests for trends were used to determine changes and trends in MDR-TB and pre-extensively drug-resistantTB (pre-XDR-TB) patterns over time. Univariate and multivariate logistic regression analysis was used to explore the risk factors of MDR-TB.ResultsCompared with DR-TB patients with DM, DR-TB patients without DM had significantly higher rates of mono-resistant streptomycin (SM) and any resistance to kanamycin (KM), but significantly lower rates of any resistance to protionamide (PTO) and mono-resistance to levofloxacin (LFX), and pre-XDR-TB (P<0.05). The proportion of resistance to other anti-TB drugs was not statistically different between the DR-TB with and without DM. Among DR-TB patients without and with DM, the proportion of patients with MDR-TB and pre-XDR-TB patterns showed a significant downward trend from 2016 to 2021 (P<0.05). Among DR-TB patients without DM, male, previously treated DR-TB cases, and immigration were risk factors for MDR-TB (P<0.05). In DR-TB patients with DM, a negative sputum smear is a risk factor for MDR-TB (P<0.05).ConclusionThere was no statistical difference in resistance patterns between DR-TB with and without DM, except in arbitrary resistance to PTO and KM, mono-resistant SM and LFX, and pre-XDR-TB. Great progress has been made in the prevention and control of MDR-TB and pre-XDR-TB. However, DR-TB patients with and without DM differ in their risk factors for developing MDR-TB.

The Targeted Maximum Likelihood estimation to estimate the causal effects of the previous tuberculosis treatment in Multidrug-resistant tuberculosis in Sudan.

This study used Targeted Maximum Likelihood Estimation (TMLE) as a double robust method to estimate the causal effect of previous tuberculosis treatment history on the occurrence of multidrug-resistant tuberculosis (MDR-TB). TMLE is a method to estimate the marginal statistical parameters in case-control study design. The aim of this study was to estimate the causal effect of the previous tuberculosis treatment on the occurrence of MDR-TB using TMLE in Sudan. A case-control study design combined with TMLE was used to estimate parameters. Cases were MDR-TB patients and controls were and patients who cured from tuberculosis. The history of previous TB treatment was considered the main exposure, and MDR-TB as an outcome. A designed questionnaire was used to collect a set of covariates including age, time to reach a health facility, number of times stopping treatment, gender, education level, and contact with MDR-TB cases. TMLE method was used to estimate the causal association of parameters. Statistical analysis was carried out with ltmle package in R-software. Result presented in graph and tables. A total number of 430 cases and 860 controls were included in this study. The estimated risk difference of the previous tuberculosis treatment was (0.189, 95% CI; 0.161, 0.218) with SE 0.014, and p-value (<0.001). In addition, the estimated risk ratio was (16.1, 95% CI; 12.932, 20.001) with SE = 0.014 and p-value (<0.001). Our findings indicated that previous tuberculosis treatment history was determine as a risk factor for MDR-TB in Sudan. Also, TMLE method can be used to estimate the risk difference and the risk ratio in a case-control study design.

Risk factors of multidrug resistant tuberculosis among patients with tuberculosis at selected multidrug resistance treatment initiative centres in southern Ethiopia: a case-control study

ObjectiveTo identify the risk factors for multidrug resistant tuberculosis (MDR-TB) among patients with TB at selected MDR-TB treatment initiative centres, southern Ethiopia, 2021.DesignAn unmatched case-control study was employed.SettingMultidrug resistance treatment...

A meta-analysis of risk factors for multidrug-resistant tuberculosis in China

Objective: To explore the main risk factors of multidrug-resistant tuberculosis (MDR-TB) in China and to provide evidence-based evidence for MDR-TB preventon and control. Methods: All relevant literatures were searched in thedatabases, such as Pubmed, Web of Science and CNKI, Wanfang, VIP and SinoMed from 2000 to 2021. Quality evaluation and data extraction were carried out, and then a meta-analysis was performed using Stata 16.0 software. Results: A total of 59 literatures (36 cross-sectional and 23 case-control) including 75 793 participants were included in this study, and meta-analysis results showed age (OR=1.27, 95%CI: 1.05-1.54), education level (OR=1.29, 95%CI: 1.02-1.65), positive sputum smear (OR=2.56, 95%CI: 1.09-6.04), pulmonary cavity (OR=1.99, 95%CI: 1.57-2.52), course of disease (OR=4.25, 95%CI: 1.95-9.30), history of tuberculosis treatment (OR=6.42,95%CI:5.40-7.63), treatment interruption (OR=2.81, 95%CI: 1.50-5.29), irregular medication (OR=5.02, 95%CI: 2.95-8.54), adverse drug reactions (OR=4.27, 95%CI: 2.22-8.19), combined chronic obstructive pulmonary disease (COPD) (OR=2.21, 95%CI: 1.45-3.37), tuberculosis exposure history (OR=1.99, 95%CI: 1.36-2.91), smoking history (OR=1.35, 95%CI: 1.09-1.66) and floating population (OR=1.60, 95%CI: 1.04-2.44) were associated with the occurrence of MDR-TB. Conclusions: The high risk groups were farmer, low education level, pulmonary cavity, long course of disease, history of tuberculosis treatment, treatment interruption, irregular medication, adverse drug reaction, co-COPD, contact history of tuberculosis, smoking history, rural residence, and floating population. We should pay attention to high-risk groups, strengthen management and take effective measures such as early screening, knowledge education on tuberculosis, standardized and personalized treatment and whole-course supervision.

Risk factors associated to multidrug-resistant tuberculosis in patients attending the deido district hospital of Douala - Cameroon.

Multidrug-resistant tuberculosis (MDR-TB) is defined as resistance to at least isoniazid and rifampicin. In Cameroon, the prevalence is estimated at 150 cases/100,000 inhabitants or 6000 cases out of an estimated population of 3 million. The aim of the present study was to determine the risk factors associated with MDR-TB at Deido District Hospital located in the littoral region of Cameroon. This was a cross-sectional and analytical retrospective study. Our sample included all TB patients undergoing treatment at the Diagnostic and Treatment Center of the hospital from January 2019 to August 2020. Identified risk factors of MDR-TB were analyzed using the SPSS software version 20.0. A total of 304 participants were enrolled with a predominance of 185 (60.8%) men. The average age was 35 years (29-43 years). About 122/304 (40%) of the patients suffered from MDR-TB. The significant factors associated with MDR-TB were occupation (adjusted odd ratio [aOR] = 61.46), monthly income (aOR = 0.11), history of TB (aOR = 5.3), alcohol consumption (aOR = 12.7); self-medication (aOR = 5.4) and consultation of traditional healers for any cure (aOR = 155.84). The emergence of MDR-TB associated with several risk factors in the study area is worrisome and can be prevented by improving the living conditions of patients and putting in place appropriate treatment strategies.

Drug Resistance Patterns and Trends in Patients with Suspected Drug-Resistant Tuberculosis in Dalian, China: A Retrospective Study.

PurposeThe emergence of drug-resistant tuberculosis (DR-TB) represents a threat to the control of tuberculosis. This study aimed to estimate the patterns and trends of DR-TB in patients with suspected DR-TB. In addition, risk factors for multidrug-resistant tuberculosis (MDR-TB) were identified among suspected DR-TB patients in Dalian, China.Patients and MethodsA total of 5661 patients with suspected DR-TB from Jan 1, 2013 to Dec 31, 2020 were included in the final analysis. The resistance pattern of all resistant strains was determined by drug susceptibility testing (DST) using the conventional Lowenstein-Jensen Proportion Method (LJ). DR-TB trends were estimated from 2013 to 2020. During the research period, the chi-square test was employed to analyze the significance of linear drug-resistance trends across time. Bivariate and multivariate logistic regression were performed to assess factors associated with MDR-TB.ResultsFrom 2013 to 2020, the resistance rates of rifampicin (RFP) and isoniazid (INH) decreased significantly, whereas the resistance rates of ethambutol (EMB) and streptomycin (SM) increased in patients with suspected DR-TB. From 2013 to 2020, the prevalence of DR-TB decreased in all patients from 34.71% to 28.01% with an average annual decrease of 3.02%. Among new cases, from 2013 to 2020, the prevalence of DR-TB (from 26.67% to 24.75%), RFP-resistant TB (RR-TB) (from 15.09% to 3.00%) and MDR-TB (from 6.08% to 2.62%) showed a significant downward trend. Among patients with a previous treatment history, DR-TB (from 54.70% to 37.50%), RR-TB (from 44.16% to 11.49%) and MDR-TB (from 26.90% to 10.34%) showed a significant downward trend from 2013 to 2020. Males (AOR 1.28, 95% CI 1.035–1.585), patients 45 to 64 years of age (AOR 1.75, 95% CI 1.342–2.284), patients 65 years and older (AOR 1.65, 95% CI 1.293–2.104), rural residents (AOR 1.24, 95% CI 1.014–1.519) and a previous treatment history (AOR 3.94, 95% CI 3.275–4.741) were risk factors for MDR-TB.ConclusionThe prevalence of DR-TB, RR-TB and MDR-TB was significantly reduced from 2013 to 2020. Considerable progress has been made in the prevention and treatment of DR-TB during this period. However, the increasing rate of drug resistance in EMB and SM should be taken seriously. Suspected DR-TB patients who are male, older than 45 years of age, live in rural areas, and have a history of TB treatment should be given priority by health care providers.

Risk factors for multidrug-resistant tuberculosis: A worldwide systematic review and meta-analysis.

BackgroundSince multidrug-resistant tuberculosis (MDR-TB) is a significant public health problem worldwide, identifying associated risk factors is critical for developing appropriate control strategies.MethodsA systematic review and meta-analysis was conducted for identifying factors independently predicting MDR-TB. The random-effects model was used to determine pooled odds ratios (ORs) and respective 95% confidence intervals (CIs) for the related factors.ResultsOf the 2301 retrieved reports, 28 studies were analyzed, assessing 3152 MDR-TB and 52715 DS-TB cases. Totally 22 related factors were analyzed. The pooled ORs were 1.478 (95%CI 1.077–2.028) for positive sputum AFB smear, 1.716 (95%CI 1.149–2.564) for lung cavity, 6.078 (95%CI 2.903–12.725) for previous TB disease and 5.427 (95%CI 3.469–8.490) for a history of anti-TB therapy. All Z test p values were below 0.05, indicating these parameters were significantly associated with MDR-TB.ConclusionsPositive sputum AFB smear, lung cavity, previously diagnosed TB and a history of anti-TB therapy are significant risk factors for MDR-TB, which are independent of the clinical setting worldwide. Increased attention should be paid to cases with such parameters to achieve more effective TB control and avoid MDR-TB through the development of a global policy.

Clinical profile and risk stratification in multidrug-resistant tuberculosis (MDR-TB) and non-MDR-TB patients: A prospective study in a tertiary care hospital

Background: Multidrug resistant tuberculosis (MDR-TB) is a major threat for successful control of TB. Early diagnosis and drug sensitivity testing helps in improving disease prevalence. This study was undertaken to determine clinical profile and risk factors for MDR-TB and factors differentiating it from non MDR-TB. Materials and methods: This is a prospective study conducted at a TB hospital attached to Vijayanagara institute of medical sciences, Bellary, Karnataka in South India over a period of 2 years. All patients diagnosed with MDR-TB were studied for clinical parameters and another cohort of non MDR-TB in same study period were included for comparison. Clinical and radiological characteristics, and risk factors were compared between two groups. Results: A total of 59 MDR-TB and 72 non MDR-TB patients were studied in this period. Males were predominant in both groups. Body mass index (BMI) was significantly low in MDR-TB group (18.5 vs 20.3 kg/m2). Among clinical symptoms, breathlessness was significantly seen in MDR-TB group. Defaulter, failure and relapse were seen in 6.8%, 54.3% and 37.3% respectively. Cavitary lesions and reticulonodular patterns in imaging were significantly seen in MDR group. Eight patients in non MDR group had human immunodeficiency virus (HIV) infection compared to one patient in MDR. Conclusion: Presence of cavity and reticulonodular patterns in imaging, significant breathlessness and lower BMI are significantly common in MDR TB patients. These parameters maybe considered for early suspicion and monitoring for drug resistance in index presentation. Keywords: multidrug resistant TB; breathlessness; human immunodeficiency virus; cavity lesion; reticulonodular patterns

Barriers and strategies to successful tuberculosis treatment in a high-burden tuberculosis setting: a qualitative study from the patient\u2019s perspective

BackgroundPreviously treated tuberculosis (TB) patients are a widely reported risk factor for multidrug-resistant tuberculosis. Identifying patients’ problems during treatment is necessary to control TB, especially in a high-burden setting. We therefore explored barriers to successful TB treatment from the patients’ perspective, aiming to identify potential patient-centred care strategies to improve TB treatment outcome in Indonesia.MethodsA qualitative study was conducted in a province of Indonesia with high TB prevalence. Participants from various backgrounds (i.e., TB patients, physicians, nurses, pharmacists, TB activist, TB programmers at the district and primary care levels) were subject to in-depth interviews and focus group discussions (FGDs). All interviews and FGDs were transcribed verbatim from audio and visual recordings and the respective transcriptions were used for data analysis. Barriers were constructed by interpreting the codes’ pattern and co-occurrence. The information’s trustworthiness and credibility were established using information saturation, participant validation and triangulation approaches. Data were inductively analysed using the Atlas.ti 8.4 software and reported following the COREQ 32-items.ResultsWe interviewed 63 of the 66 pre-defined participants and identified 15 barriers. The barriers were classified into three themes, i.e., socio-demography and economy; knowledge and perception and TB treatment. Since the barriers can be interrelated, we determined five main barriers across all barrier themes, i.e., lack of TB knowledge, stigmatisation, long distance to the health facility, adverse drug reaction and loss of household income.ConclusionThe main treatment barriers can be considered to strengthen patient-centred care for TB patients in Indonesia. A multi-component approach including TB patients, healthcare providers, broad community and policy makers is required to improve TB treatment success.

Multi-Resistant Tuberculosis in Western Algeria: about 36 Cases

Multi-drug resistant tuberculosis (MDR-TB) is defined by the loss of susceptibility of Mycobacterium tuberculosis complex strains to the two major anti-tuberculosis drugs: isoniazid (H) and Rifampicin (R). This resistance may be acquired or primary. The aim of our study was to describe the epidemiological, clinical, bacteriological and evolutionary profile of multi-resistant tuberculosis patients in Western Algeria. To do so, aretrospective analytical study, which included 36 patients, was carried out in the pneumo-phthisiology department (B) of the Oran University Hospital (West Algeria) from January 2010 to December 2014. Our result showed an average age of 33.7 years. The risk factors for MDR-TB highlighted were tobacco (n=12; 33.3%), alcoholism (n=1; 2.8%) and family history of MDR-TB (n=3; 8.33). Primary MDR-TB was present in 11.11% of cases and secondary MDR-TB in 88.89% of cases. There was resistance to H and R in 13.8% of cases (n=5); to H, R and Streptomycin (S) in 50% of cases (n=18); to H, R and Ethambutol (E) in 5.6% of cases (n=2). The percentage of patients who had lost the sensitivity of the Bacillus to the four first-line anti-tuberculosis drugs (H, R, S, and E) was 25% of all patients tested (n=9) and H, R, S, and Ofloxacin (O) in one case. Five patients died. The rate of primary resistance found in this study constitutes a threat to efforts to control MDR tuberculosis in Algeria. It is therefore important to update the results and assess the extent of the problem.

Incidence Density and Predictors of Multidrug-Resistant Tuberculosis Among Individuals With Previous Tuberculosis History: A 15-Year Retrospective Cohort Study.

Background: To date, too little attention has been paid to monitoring and estimating the risk of incident multidrug-resistant tuberculosis (MDR-TB) among individuals with a previous tuberculosis history (PTBH). The purpose of this study was to assess the incidence of and risk factors for MDR-TB in those individuals.Methods: Between 2005 and 2020, a large, retrospective, population-based cohort study was performed in Hangzhou, China. A multivariable Cox regression model was used to evaluate independent predictors of incident MDR-TB among individuals with PTBH.Results: The incidence density of MDR-TB was 22.6 per 1,000 person-years (95% confidence level and an interval of 20.9–24.3) for individuals with PTBH. The incidence of MDR-TB increased significantly in individuals who• were under 60 years old.• were male.• had a history of direct contact.• came from low-income families.• worked in high-risk occupations.• lived in rural areas.• had a retreatment TB history.• had an unfavorable outcome in their previous treatment (P < 0.05).In addition, we found that the following factors were significantly linked to the MDR-TB risk among individuals with PTBH (P < 0.05):• sociodemographic factors such as the 21–30 and 31–40 year age groups, or a history of direct contact.• clinical factors like passive modes of TB case finding (PMTCF), human immunodeficiency virus infection, unfavorable treatment outcomes, retreated TB history, non-standardized treatment regimens of retreatment TB patients, and duration of pulmonary cavities (DPC).• microbiological factors, such as duration of positive sputum culture.We also found that the 21–30 year age group, low family income, and PMTCF were significantly linked to incident MDR-TB only in males with PTBH, whilst the 41–50 year age group, extended treatment course, and DPC were significantly associated with female MDR-TB only.Conclusion: The incidence of MDR-TB was high, with a higher rate among subjects with a history of direct contact and unfavorable treatment outcomes. There was a gender difference in the incidence density and risk factors of MDR-TB among individuals with PTBH. Long-term monitoring and gender-specific risk-factor modifications should be given to individuals with PTBH.

Survival analysis of patients with tuberculosis and risk factors for multidrug-resistant tuberculosis in Monrovia, Liberia.

We reviewed the records of 337 confirmed cases of tuberculosis patients in Monrovia, the capital of Liberia, 2015. The risk factors affecting the survival and multidrug-resistance of tuberculosis patients were examined. Kaplan-Meier analysis and the log-rank test were used to assess the differences in survival among the patients, while Cox regression model was used for multivariate analysis. The qualitative data was tested with chi-square test in the single factor analysis of multidrug-resistant TB. Multivariate analysis was performed using binary logistic regression analysis. The significance level for all the tests were set at 0.05. The mean period of the follow-up of patients was 10 months. In the 337 patients, 33 (9.8%) died, the 21-month survival rate was 90.2%. The results of multivariate Cox regression analysis show that overcrowding (HR = 7.942, 95% CI 3.258–19.356), former smoking (HR = 3.773, 95% CI 1.601–8.889), current smoking (HR = 3.546, 95% CI 1.195–10.521), multidrug-resistance tuberculosis (HR = 4.632, 95% CI 1.913–11.217) were risk factors for death during anti-tuberculosis treatment in TB patients in Liberia. The results of binary logistic regression analysis show that extra-pulmonary (OR = 2.032, 95% CI 1.133–3.644), family history of TB (OR = 2.387, 95% CI 1.186–4.807) and current smoking (OR = 3.436, 95% CI 1.681–7.027) were risk factors for multidrug-resistant tuberculosis. These results can provide insights on local tuberculosis early intervention, increase public health awareness, and strengthen the control of factors that may affect the survival and multidrug-resistance of tuberculosis patients.

Evaluation of risk factors associated with the development of MDR- and XDR-TB in a tertiary care hospital: a retrospective cohort study.

BackgroundDrug resistant tuberculosis (DR-TB) infringes substantial burden in terms of longer treatment duration, morbidity and mortality. Timely identification of patients at risks of DR-TB will aid individualized treatment. Current study was aimed to ascertain several factors associated with DR-TB among patients attending a tertiary care hospital.MethodsThis retrospective study was conducted among patients with confirmed diagnosis of DR-TB and drug susceptible TB (DS-TB) seeking medical care from a tertiary care hospital during 2014–2019. The types of DR-TB included were rifampicin resistant tuberculosis (RR-TB), Multidrug resistant tuberculosis (MDR-TB) and extensively drug resistant tuberculosis (XDR-TB). Appropriate statistical methods were implied to evaluate the factors associated with DR-TB.ResultsOut of 580 patients, DS-TB was diagnosed in 198 (34.1%) patients while DR-TB was present in 382 patients. Of resistance cases, RR-TB, MDR-TB and XDR-TB were diagnosed in 176 (30.3%), 195 (33.6%) and 11 (1.9%) patients, respectively. Significant differences (P < 0.05) in demographics and clinico-laboratory characteristics were observed between patients with DS-TB and DR-TB. Logistic regression analysis revealed age ≤38 years (OR: 2.5), single marital status (OR: 11.1), tobacco use (OR: 2.9), previous treatment (OR: 19.2), treatment failure (OR: 9.2) and cavity on chest X-ray (OR: 30.1) as independent risk factors for MDR-TB. However, XDR-TB was independently associated with age group of ≤38 years (OR: 13.6), students (OR: 13.0), previous treatment (OR: 12.5), cavity on chest X-ray (OR: 59.6). The independent risk factors associated with RR-TB are age ≤38 years (OR: 2.8), females (OR: 5.7), unemployed (OR: 41.5), treatment failure (OR: 4.9), previous treatment (OR: 38.2) and cavity on chest X-ray (OR: 4.3). ROC curve analysis accentuate the excellent predictive accuracy of all logistic regression models as shown by AUC (0.968, P < 0.001) for MDR-TB, AUC (0.941, P < 0.001) for XDR-TB and AUC (0.962, P < 0.001) for RR-TB.ConclusionsCurrent study demonstrates a sizeable extent of resistant cases among pulmonary TB patients. This study presaged significant risk of DR-TB among females, young adults, unemployed, smokers, patients with previous treatment failure and cavitation on chest X-ray. Timely identification of high risk patients will give pronounced advantages regarding appropriate choices of prevention, treatment and disease control.