Risk Factors For Multidrug-resistant Tuberculosis Research Articles

Health Belief Model and PRECEDE PROCEED on the Risk Factors of Multidrug Resistant Tuberculosis in Surakarta, Central Java

Background : Tuberculosis (TB) is one of the lethal infectious diseases in the world. One of the current biggest challenges of Tuberculosis control is the widespread emergence of Multidrug Resistant Tuberculosis (MDR-TB). There are several potential risk factors of MDR-TB that can be explained by Health Belief Model and PRECEDE PROCEED model framework. This study aimed to analyzed factors associated with MDR-TB using Health Belief Model and PRECEDE PROCEED. Subjects and Method : This was an analytic observational study with case control design. The study was conducted at Dr. Moewardi Hospital and BBKPM, Surakarta, from September to November 2017. The study subjects were selected using fixed disease sampling, consisting of 76 MDR-TB patients and 228 TB patients. The dependent variable was MDR-TB. The independent variables were educational level, self-efficacy, drug-taking adherence, smoking, nutritional status, perceived of susceptibility, perceived barrier, perceived severity, perceived benefit, and drug-taking supervisor. The data were collected using questionnaire and analyzed by path analysis. Results : The risk of MDR-TB was increased by lack of drug-taking adherence (b= -1.69; 95% CI= -2.28 to -1.09; p <0.001), poor nutritional status (b= 1.32; 95% CI= 0.72 to 1.92; p<0.001), and smoking (b= 1.32; 95% CI= 0.72 to 1.92; p <0.001). Drug-taking adherence was increased by perceived susceptibility  (b= 0.91; 95% CI= 0.18 to 1.63; p=0.015), perceived severity  (b= 1.01; 95% CI=  0.28 to 1.74; p=0.007), perceived benefit (b= 1.69; 95% CI= 0.97 to 2.41; p<0.001), drug-taking advisor (b= 2.16; 95% CI= 1.44 to 2.88; p<0.001), self efficacy (b= 1.58; 95% CI= 0.86 to 2.31; p<0.001), and low perceived barrier (b= -1.10; 95% CI= -1.82 to -0.38; p=0.003). Conclusion : The risk of MDR-TB is increased by the lack of drug-taking adherence, poor nutritional status, and smoking. Keyword : Health belief model, PRECEDE-PROCEED, MDR-TB Correspondence: Vera. Masters Program in Public Health, Sebelas Maret University, Jl. Ir. Sutami 36 A, Surakarta 57126, Central Java. Email: vera21210@gmail.com Journal of Epidemiology and Public Health (2017), 2(3): 241-254 https://doi.org/10.26911/jepublichealth.2017.02.03.06

Risk factors for multidrug-resistant tuberculosis in the city of Kinshasa in the Democratic Republic of Congo

IntroductionL'objectif de cette étude était de déterminer les facteurs de risque associés à la tuberculose multi résistance à Kinshasa en République Démocratique du Congo.MéthodesIl s'agissait d'une étude cas témoins. Les cas comprenaient tous les patients tuberculeux résistants à la rifampicine et à l'isoniazide notifiés à Kinshasa de janvier 2012 à juin 2013. Les témoins étaient les patients tuberculeux traités durant la même période que les cas et qui à la fin du traitement étaient déclarés guéris. Pour cette étude, nous avons obtenu une clairance éthique.RésultatsL’échantillon était constitué de 213 participants dont 132 hommes (62%) et 81 femmes (38%). L’âge médian était de 31ans (16-73 ans). Les facteurs associés significatifs (p< 0,05) à la tuberculose multi résistante étaient le non-respect des heures de prise de médicaments (0R = 111) (80% chez les cas et 4% chez les témoins), l’échec au traitement (0R = 20) (76% chez les cas et 13% chez les témoins); la notion de tuberculose multi résistante dans la famille (0R = 6.4) (28% chez les cas et 6% chez les témoins); la méconnaissance de la tuberculose multi résistante (0R = 3.2) (31% chez les cas et 59% chez les témoins); un séjour en prison (0R = 7.6) (10% chez les cas et 1% chez les témoins) et l'interruption du traitement (0R = 6.1) ( 59% chez les cas et 19% chez les témoins).ConclusionL’émergence de la tuberculose multi résistante peut être évitée par la mise en place des stratégies de diagnostic et de traitement appropriées.

Meta-analysis on risk factors of multidrug resistant tuberculosis in China

To synthetically evaluate the risk factors of multidrug resistant tuberculosis (MDR-TB) in China. Chinese databases (CNKI, Wanfang, SinoMed and VIP) and English database (PubMed) were used to collect studies on risk factors for MDR-TB from 1990 to 2013. Meanwhile, relevant studies were manually retrieved. According to the inclusion and exclusion criteria, studies were screened, data were extracted and quality assessed. A Meta-analysis was performed by using Stata 11.0 software. Twenty five studies on the risk factors of MDR-TB were synthetically and quantitatively analyzed. The results of Meta-analysis showed that factors as: being Han ethnic group, history of tuberculosis treatment, pulmonary cavity, floating population, TB case contact history, regular medication, living in rural areas, and poor economy were associated with the incidence of MDR-TB, the pooled OR values were 3.12 (95%CI: 1.16-8.40) , 5.27 (95% CI:3.60-7.72) , 1.39 (95%CI:1.03-1.87) , 1.69 (95%CI: 1.07-2.68) , 4.34 (95%CI: 1.91-9.86) , 0.23 (95% CI: 0.16-0.35) , 1.86 (95% CI: 1.59-2.18) and 1.62 (95% CI: 1.34-1.96) , respectively. Factors as: being Han ethnic group, history of tuberculosis treatment, pulmonary cavity, floating population, TB case contact history, living in rural areas and poor economy were considered to be at risk of MDR-TB while regular medication might be a protective factor to MDR-TB.

Previous treatment, sputum-smear nonconversion, and suburban living: The risk factors of multidrug-resistant tuberculosis among Malaysians

The number of multidrug-resistant tuberculosis patients is increasing each year in many countries all around the globe. Malaysia has no exception in facing this burdensome health problem. We aimed to investigate the factors that contribute to the occurrence of multidrug-resistant tuberculosis among Malaysian tuberculosis patients. An unmatched case-control study was conducted among tuberculosis patients who received antituberculosis treatments from April 2013 until April 2014. Cases are those diagnosed as pulmonary tuberculosis patients clinically, radiologically, and/or bacteriologically, and who were confirmed to be resistant to both isoniazid and rifampicin through drug-sensitivity testing. On the other hand, pulmonary tuberculosis patients who were sensitive to all first-line antituberculosis drugs and were treated during the same time period served as controls. A total of 150 tuberculosis patients were studied, of which the susceptible cases were 120. Factors found to be significantly associated with the occurrence of multidrug-resistant tuberculosis are being Indian or Chinese (odds ratio 3.17, 95% confidence interval 1.04–9.68; and odds ratio 6.23, 95% confidence interval 2.24–17.35, respectively), unmarried (odds ratio 2.58, 95% confidence interval 1.09–6.09), living in suburban areas (odds ratio 2.58, 95% confidence interval 1.08–6.19), are noncompliant (odds ratio 4.50, 95% confidence interval 1.71–11.82), were treated previously (odds ratio 8.91, 95% confidence interval 3.66–21.67), and showed positive sputum smears at the 2nd (odds ratio 7.00, 95% confidence interval 2.46–19.89) and 6th months of treatment (odds ratio 17.96, 95% confidence interval 3.51–91.99). Living in suburban areas, positive sputum smears in the 2nd month of treatment, and was treated previously are factors that independently contribute to the occurrence of multidrug-resistant tuberculosis. Those with positive smears in the second month of treatment, have a history of previous treatment, and live in suburban areas are found to have a higher probability of becoming multidrug resistant. The results presented here may facilitate improvements in the screening and detection process of drug-resistant patients in Malaysia in the future.

A risk calculator for multidrug-resistant tuberculosis in London, UK

BackgroundRapid nucleic acid amplification technologies provide a fast and effective way to diagnose multidrug-resistant (MDR) tuberculosis. However, the number of false positive results produced by overtesting in low risk groups is a concern. With present estimates of the burden of MDR tuberculosis in the UK and rapid test sensitivity and specificity, the expected positive predictive value for testing all patients with tuberculosis is 0·47. Treatment for MDR tuberculosis is time-consuming and expensive, with severe side-effects for patients. Therefore an accessible risk calculator that can be used by clinicians to effectively target rapid testing is needed. MethodsUsing enhanced tuberculosis surveillance data collected through the London TB Register (a web-based system used by all TB clinics within the city) from 2009 to 2013, we developed a multivariable risk prediction model based on a-priori risk factors of MDR tuberculosis in London. Bootstrapping was used to internally validate the model, and external validation was done with national tuberculosis data from the same time period. FindingsOf 7292 individuals, 134 (1·83%) tested positive for MDR tuberculosis. In a multivariable penalised logistic regression model, the strongest risk factors associated with MDR tuberculosis included previous diagnosis, the burden of MDR tuberculosis in a patient's country of birth, recent arrival in the UK if foreign born, and age, with younger individuals at higher risk (appendix). The calibration slope was 0·90 after internal validation, and the area under the receiver operating characteristic curve (AUC) decreased from 0·73 to 0·70; this small reduction suggested satisfactory performance. Non-parametric calibration curves indicated accurate prediction for most patients, but with overestimated risk predicted for higher risk individuals. On an external dataset of 9652 patients, AUC was 0·74 with a calibration slope of 0·99. If only higher risk (>2%) patients were rapidly tested, we estimated that the positive predictive value would increase to 0·65. InterpretationThe model has been developed into a working calculator in Excel; the algorithms could also be integrated into surveillance registers to support embedding into clinical practice. Future research could include health economic work to help identify a range of cut-off risks at which testing is worthwhile. The model would need validating with local data before use in other countries. FundingOD is supported by a National Institute for Health Research (NIHR) Research Methods Fellowship.

Multidrug resistant tuberculosis: prevalence and risk factors in districts of metema and west armachiho, Northwest Ethiopia.

BackgroundMulti drug resistant tuberculosis (MDR-TB) is an emerging challenge for TB control programs globally. According to World health organization, 2012 report Ethiopia stands 15th out of the 27 high priority countries in the world and 3rd in Africa. Updated knowledge of the magnitude of MDR-TB is so substantial to allocate resources, and to address prevention and control measures. Therefore, the aim of this study was to assess the prevalence of MDR-TB and associated risk factors in West Armachiho and Metema districts of North Gondar.MethodsA cross-sectional study was conducted in West Armachiho and Metema districts between February 01 and June 25, 2014. A total of 124 consecutive smear positive pulmonary tuberculosis patients were included in the study. Socio-demographic and possible risk factor data were collected using a semi-structured questionnaire. Drug susceptibility testing was first performed for rifampicin using GeneXpert MTB/RIF. For those rifampicin resistant strains, drug susceptibility testing was performed for both isoniazid and rifampicin to identify MDR-TB using the proportional method on LJ media. Data were analyzed using statistical Package SPSS version 20; binary logistic regression was used to assess the association. P-values < 0.05 were considered as statistically significant.ResultsOf 124 smear-positive pulmonary TB patients, 117 (94.4 %) were susceptible to Rifampicin, while 7 (5.7 %) were confirmed to be resistant to Rifampicin and Isoniazid. The overall prevalence of MDR-TB was 5.7 % (2.3 % among new cases and 13.9 % among previously treated cases). History of previous treatment (OR = 7, P = 0.025) was significantly associated risk factor for MDR-TB.ConclusionThe overall prevalence of MDR-TB was 5.7 % among cases at five health centers and a history of previous treatment was found to be a risk factor for being infected by an MDR-TB strain. Therefore, maximizing early case detection and treatment, strengthening TB infection control activities and proper implementation of DOTS are recommended to reduce the burden of MDR-TB.

Risk Factors for Multidrug-Resistant Tuberculosis among Patients with Pulmonary Tuberculosis at the Central Chest Institute of Thailand

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.

Factors related to previous tuberculosis treatment of patients with multidrug-resistant tuberculosis in Bangladesh

ObjectivePrevious tuberculosis (TB) treatment status is an established risk factor for multidrug-resistant TB (MDR-TB). This study explores which factors related to previous TB treatment may lead to the development of...

Risk factors for multidrug resistant tuberculosis patients in Amhara National Regional State.

Multidrug resistant tuberculosis(MDR-TB) is becoming a major threat to tuberculosis control programs in Ethiopia. To determine risk factors of MDR-TB patients in Amhara National Regional State, Ethiopia. Case-control study was conducted from May 2013 to January 2014. Resistance to rifampicin and isoniazid were done molecularly using line probe assay. TB patients infected with MDR-M.tuberculosis and non MDR-M.tuberculosis strain were considered as cases and controls, respectively. Data was collected using structured questionnaire with face to face interview. Patients' clinical record review was also done.Multivariate analysis was computed to determine the risk factors of MDR-TB. A total of 153 MDR-TB and equal number of non MDR-TB patients' participated in the study. Patients who had TB treatment failure (AOR=13.5,CI=2.69-70), cavitations on chest x-ray (AOR=1.9,CI=1.1-3.38) and contact with MDR-TB patients (AOR=1.4,CI=0.19-0.39) were more likely to be MDR-TB patients. Low monthly income (AOR=1.1,CI=0.34-0.47),alcohol consumption (AOR=1.5,CI=0.2-0.98) and young age (AOR=2.9,CI=1.07-7.68) were the other risk factors of MDR-TB. TB treatment failure, cavitation on chest X-ray, contact with MDR-TB patients and low socioeconomic status were important risk factors for development of MDR-TB. Therefore, strict adherence to directly observed therapy, appropriate management of TB patients and advice on the value of nutrients are helpful to control the spreading of MDR-TB.

Multidrug-resistant tuberculosis in Europe, 2010-2011.

Drug-resistant Mycobacterium tuberculosis is challenging elimination of tuberculosis (TB). We evaluated risk factors for TB and levels of second-line drug resistance in M. tuberculosis in patients in Europe with multidrug-resistant (MDR) TB. A total of 380 patients with MDR TB and 376 patients with non-MDR TB were enrolled at 23 centers in 16 countries in Europe during 2010-2011. A total of 52.4% of MDR TB patients had never been treated for TB, which suggests primary transmission of MDR M. tuberculosis. At initiation of treatment for MDR TB, 59.7% of M. tuberculosis strains tested were resistant to pyrazinamide, 51.1% were resistant to ≥1 second-line drug, 26.6% were resistant to second-line injectable drugs, 17.6% were resistant to fluoroquinolones, and 6.8% were extensively drug resistant. Previous treatment for TB was the strongest risk factor for MDR TB. High levels of primary transmission and advanced resistance to second-line drugs characterize MDR TB cases in Europe.

Risk Factors for Multi-drug Resistant Tuberculosis in Addis Ababa, Ethiopia

Multi-Drug resistant Tuberculosis (MDR-TB) is becoming a major challenge of the tuberculosis (TB) control program in Ethiopia. The objective of the study was to investigate risk factors for MDR-TB in Addis Ababa. Comparative cross-sectional study was conducted to determine the risk factors for MDR-TB in Addis Ababa. MDR and non MDR-TB cases were compared on key socio-demographic and patient related clinical features for multidrug-resistance. A total 439 (113 MDR-TB and 326 non MDR-TB) were enrolled in to the study. Standard data abstraction instrument were used. Data were entered and analysed using SPSS version 18 for windows. Initial descriptive analyses of all variables of interest, odds ratio, univariate and subsequent multiple regression analysis was carried out. Male sex (OR 2, 95%CI 1.4-5), younger age of 15-34 years (OR 2.8, 95%CI 1.7-6.4), twice or more episodes of TB treatment (OR 14, 95%CI 1.3-9), treatment category of failure after re-treatment (OR 4, 95%CI 2.5-6.83), pulmonary TB (OR 2, 95%CI 1.7-5) and TB/HIV co-infection (OR 2.66, 95%CI 1.32-5.6) were associated with the risks of becoming ill with MDR-TB. The national TB prevention and control programme should be given priority for routine Line Probe Assay to make early diagnosis of MDR-TB particularly among those identified risk groups.

Diabetes and Other Risk Factors for Multi-drug Resistant Tuberculosis in a Mexican Population with Pulmonary Tuberculosis: Case Control Study

Multidrug resistant tuberculosis (MDR-TB) poses problems in treatment, costs and treatment outcomes. It is not known if classically described risk factors for MDR-TB in other countries are the same in Mexico and the frequency of the association between diabetes mellitus (DM) and MDR-TB in our country is not clear. We undertook this study to analyze risk factors associated with the development of MDR-TB, with emphasis on DM. A case-control study in the state of San Luis Potosi (SLP), Mexico was carried out. All pulmonary MDR-TB patients diagnosed in the state of SLP between 1998 and 2013 (36 cases) evaluated at a state pharmacoresistant tuberculosis (TB) clinic and committee; 139 controls were randomly selected from all pulmonary non-multidrug-resistant tuberculosis (non-MDR-TB) cases identified between 2003 and 2008. Cases and controls were diagnosed and treated under programmatic conditions. Age, gender, malnutrition, being a health-care worker, HIV/AIDS status, and drug abuse were not significantly different between MDR-TB and non-MDR-TB patients. Significant differences between MDR-TB and non-MDR-TB patients were DM (47.2 vs. 28.1%; p = 0.028); previous anti-TB treatments (3 vs. 0, respectively; p <0.001), and duration of first anti-TB treatment (8 vs. 6 months, respectively; p <0.001). MDR-TB and DM are associated in 47.2% of MDR TB cases (17/36) in this study. Other recognized factors were not found to be significantly different in MDR-TB compared to non-MDR-TB in this study. Cost-feasible strategies must be implemented in the treatment of DM-TB in order to prevent the selection of MDR-TB.

Profil clinique, microbiologique et évolutif des patients en situation d’échecs et de rechutes de tuberculose en Côte d’Ivoire

Multidrug-resistant tuberculosis (MDR-TB) is a major obsession for TB control. The main risk factor for MDR-TB remains a history of TB treatment especially bad conduct. The objective of this study is to describe the profile of patients in situations of failure and relapse of tuberculosis. We performed a retrospective survey of the analysis of records of patients starting TB retreatment for failure or relapse of tuberculosis. We used 193 cases with results of culture-sensitivity. The proportion of failure is 59/193 (30.6 %) and cases of relapse are 134/193 (69.4 %). The proportion of married life is 23.4 % (11/47) in chess against 41.5 % (51/123) in relapse of TB [P=0.021, OR=0.431 (0.201 to 0.927)]. Patients failing therapy have more chest pain [5.8 % (3/52) versus 0 % (0/126) with P=0.024]. The proportion of MDR-TB was 61.4 (38/59) in case of failure against 41 % (55/134) in case of relapse [P=0.002, OR=2.599 (1.378 to 4.902)]. The evolution is the same whatever the indication of reprocessing. The proportion of MDR-TB is very important in case of reprocessing failure and relapse of tuberculosis.

S76 Tb Infection In The Nepali Population In South-east London Displays Different Characteristics Compared To The Tb Population In Nepal

Introduction The World Health Organisation classifies Nepal as having high Tuberculosis (TB) burden (Estimated incidence 163/100,000). TB within the Nepali population in the UK has not been formally characterised but a recent study indicates unique characteristics compared to overall UK data. 1 These include higher rates of multi-drug resistant (MDR) TB (4.7% vs 1.6%), and lower rates of TB/HIV co-infection (1.1% vs 8%). We sought to investigate if these differences were also found in the TB population in Nepal or were unique to the immigrant population in SE London. Methods Retrospective cohort analysis was performed of all Nepali TB patients in Greenwich between 2007–2012. Data collected included site, drug resistance, HIV co-infection and completion rates. Results were compared to Nepal National Tuberculosis Programme (NTP) data from 2012. Data analysis was conducted as part of an Internship with the Britain Nepal Medical Trust. Results 86 UK patient records were analysed and compared to NTP 2012 data (n = 34,245). TB patients in Greenwich were younger than patients in Nepal; 91.8% age Of the patients diagnosed with pulmonary TB in Greenwich, only 19.7% had sputum smear positive disease, compared to 68% in Nepal. UK patients had higher rates of extrapulmonary disease compared to Nepal (41% vs. 23.8%). The rate of MDR TB in new diagnoses shows a marked difference; Greenwich having rates of 4.7% compared to 2.2% in Nepal. Despite the higher rates, risk factors for MDR TB were low in UK immigrants (HIV 1.1%, previous TB treatment 0% and MDR TB contact 0%). Treatment completion in Greenwich was 98% compared with 91% in Nepal, who run a national DOTS programme. Conclusion Nepali expatriate TB patients display different characteristics to both UK and Nepal TB populations, and have high rates of MDR TB which cannot be accounted for by increased risk factors. Further studies are required to identify if this reflect differences in TB diagnostics or relate to the migration status of the Nepali patients. References T Simpson, E Stephenson, P Palchaudhuri. A study of tuberculosis in an expatriate Nepalese community in South-East London. poster presentation. European Respiratory Society

First national survey of anti-tuberculosis drug resistance in Azerbaijan and risk factors analysis.

Civilian population of the Republic of Azerbaijan. To determine patterns of anti-tuberculosis drug resistance among new and previously treated pulmonary tuberculosis (TB) cases, and explore their association with socio-demographic and clinical characteristics. National cross-sectional survey conducted in 2012-2013. Of 789 patients (549 new and 240 previously treated) who met the enrolment criteria, 231 (42%) new and 146 (61%) previously treated patients were resistant to any anti-tuberculosis drug; 72 (13%) new and 66 (28%) previously treated patients had multidrug-resistant TB (MDR-TB). Among MDR-TB cases, 38% of new and 46% of previously treated cases had pre-extensively drug-resistant TB (pre-XDR-TB) or XDR-TB. In previously treated cases, 51% of those who had failed treatment had MDR-TB, which was 15 times higher than in relapse cases (OR 15.2, 95%CI 6-39). The only characteristic significantly associated with MDR-TB was a history of previous treatment (OR 3.1, 95%CI 2.1-4.7); for this group, history of incarceration was an additional risk factor for MDR-TB (OR 2.8, 95%CI 1.1-7.4). Azerbaijan remains a high MDR-TB burden country. There is a need to implement countrywide control and innovative measures to accelerate early diagnosis of drug resistance in individual patients, improve treatment adherence and strengthen routine surveillance of drug resistance.

Drug-resistant tuberculosis in Israel: risk factors and treatment outcomes.

All culture-positive tuberculosis (TB) isolates in Israel. To outline the magnitude of drug-resistant TB in Israel, describe treatment outcomes and identify risk factors. Retrospective study of laboratory data of all strains of adult TB patients tested for resistance to first- and second-line anti-tuberculosis drugs between 1999 and 2010. Of 4652 reported TB cases, 3552 (76.3%) underwent culture (annual range 73-81%); 445 (12.5%) were resistant to one or more first-line drugs, while 207 (5.8%) had multidrug-resistant TB (MDR-TB). Risk factors for MDR-TB included being male, age 30-59 years, migrants (mainly from the former Soviet Union [FSU]) who had stayed in Israel >2 years, and having pulmonary TB, human immunodeficiency virus (HIV) infection and sputum smear positivity. Of all MDR-TB patients, 71.0% achieved treatment success, while 19.8% died. Twelve Israeli citizens had extensively drug-resistant TB (5.8% of MDR-TB cases). All had emigrated from the FSU and had pulmonary TB; 1 was HIV-infected. Seven (58.4%) achieved treatment success and 5 (41.6%) died. Drug-resistant TB in Israel is influenced by migration, especially from the FSU, where the patients were probably infected. Rapid sputum sampling performed in the early stages of the disease, patient isolation and drug susceptibility testing should be the standard of care to avoid further transmission and improve TB control.

Development of multidrug resistant tuberculosis in Bangladesh: a case-control study on risk factors.

ObjectiveTo determine the risk factors for developing multidrug resistant tuberculosis in Bangladesh.MethodsThis case-control study was set in central, district and sub-district level hospitals of rural and urban Bangladesh. Included were 250 multidrug resistant tuberculosis (MDR-TB) patients as cases and 750 drug susceptible tuberculosis patients as controls. We recruited cases from all three government hospitals treating MDR-TB in Bangladesh during the study period. Controls were selected randomly from those local treatment units that had referred the cases. Information was collected through face-to-face interviews and record reviews. Unadjusted and multivariable logistic regression were used to analyse the data.ResultsPrevious treatment history was shown to be the major contributing factor to MDR-TB in univariate analysis. After adjusting for other factors in multivariable analysis, age group “18–25” (OR 1.77, CI 1.07–2.93) and “26–45” (OR 1.72, CI 1.12–2.66), some level of education (OR 1.94, CI 1.32–2.85), service and business as occupation (OR 2.88, CI 1.29–6.44; OR 3.71, CI 1.59–8.66, respectively), smoking history (OR 1.58, CI 0.99–2.5), and type 2 diabetes (OR 2.56 CI 1.51–4.34) were associated with MDR-TB. Previous treatment was not included in the multivariable analysis as it was correlated with multiple predictors.ConclusionPrevious tuberculosis treatment was found to be the major risk factor for MDR-TB. This study also identified age 18 to 45 years, some education up to secondary level, service and business as occupation, past smoking status, and type 2 diabetes as comorbid illness as risk factors. National Tuberculosis programme should address these risk factors in MDR-TB control strategy. The integration of MDR-TB control activities with diabetes and tobacco control programmes is needed in Bangladesh.

Factors Contributing to the High Prevalence of Multidrug-Resistant Tuberculosis Among Previously Treated Patients: A Case–Control Study from China

Multidrug-resistant tuberculosis (MDR-TB) has emerged as a serious global public health problem. In China, the risk factors for MDR-TB have not been systematically evaluated. To identify risk factors associated with MDR-TB among previously treated patients in China. A case-control study was carried out. Cases were selected from previously treated MDR-TB patients who were resistant to both isoniazid and rifampin, and controls were selected from previously treated TB patients who were sensitive to isoniazid and rifampin (non-MDR-TB). Information was collected from the registration database and a structured questionnaire. A total of 61 cases and 50 controls were recruited. A multivariate analysis showed that the family annual per-capita income ≤7,000 Yuan (odds ratio [OR]=3.238; 95% confidence interval [CI]: 1.270-8.252), no history of fixed dose combinations (FDCs) in anti-TB treatment (OR=4.027; 95% CI: 1.457-11.129), and adverse reactions in the course of TB treatment (OR=3.568; 95% CI: 1.402-9.085) were independent predictors of MDR-TB. Moreover, among the TB patients who had adverse reactions, quitting the treatment was shown as a risk factor for MDR-TB (p=0.009). In the control of MDR-TB among previously treated patients, lower socioeconomic groups, the expanding use of FDCs, and improving adherence to treatment by implementing Directly Observed Therapy Short Course-Plus (DOTS-Plus), strictly should become a priority that requires strong commitment and collaboration among health organizations.

Risk factors for multidrug resistance among previously treated patients with tuberculosis in eastern China: a case–control study

Previous treatment has been documented as a major risk factor for multidrug-resistant tuberculosis (MDR-TB). However, risk factors for MDR-TB among previously treated patients in China are unclear. This study aimed to ascertain the risk factors for MDR-TB in this particular population in China. A case-control study was conducted from July through August 2011 in five cities of Zhejiang Province. Cases were previously treated TB patients who had disease resistant to at least isoniazid and rifampin, whereas controls were previously treated TB patients who had disease sensitive to isoniazid and rifampin. Ninety-eight cases and 83 controls were identified. Multivariate analysis showed that a duration of first treatment of more than 8 months (odds ratio (OR) 2.18, 95% confidence interval (CI) 1.05-4.52), more than three prior episodes of anti-TB treatment (more than 2 months of continuous treatment as one episode) (OR 5.57, 95% CI 2.38-13.00), adverse effects of anti-TB medication (OR 3.63, 95% CI 1.79-7.36), and more than three TB foci in the lung (OR 2.17, 95% CI 1.08-4.37) were associated with MDR-TB in previously treated TB patients. Low family income (p=0.056) was marginally significant in the univariate analysis. Particular clinical diagnostic results, such as more than three TB foci in the lung, non-standard or irregular therapy, and adverse effects of anti-TB medication, were found to be associated with MDR-TB in previously treated TB patients. High quality directly observed treatment should be strengthened to ensure that the previously treated patients can receive standard and regular regimens.

Converging risk factors but no association between HIV infection and multidrug-resistant tuberculosis in Kazakhstan

Kazakhstan is a country with a low HIV/AIDS (human immunodeficiency virus/acquired immune-deficiency syndrome) burden, but a high prevalence of multidrug-resistant tuberculosis (MDR-TB). We describe the epidemiology of multidrug resistance and HIV among TB patients, using the 2007-2011 national electronic TB register. HIV test results were available for 97.2% of TB patients. HIV prevalence among TB patients increased from 0.6% in 2007 to 1.5% in 2011. Overall, 41.6% of patients had a positive smear at diagnosis, 38.6% a positive culture and 51.7% either a positive smear or culture. Drug susceptibility testing (DST) results were available for 92.7% of culture-positive cases. Socio-economic factors independently associated with both HIV and MDR-TB were urban residency, drug use, homelessness and a history of incarceration. In adjusted analysis, HIV positivity was not associated with MDR-TB (OR 1.0, 95%CI 0.86-1.2). Overall, among TB patients with DST and HIV test results available, 65.0% were positive for neither HIV nor MDR-TB, 33.5% only for MDR-TB, 0.9% only for HIV and 0.6% for both HIV and MDR-TB. Among injection drug users, 12.5% were positive for HIV and MDR-TB. We showed increasing HIV prevalence among TB patients in Kazakhstan. HIV was not an independent risk factor for MDR-TB, but risk factors were largely overlapping and we did identify subgroups at particular risk of HIV-MDR-TB co-infection, notably drug users. Enhanced efforts are necessary to provide care to these socially vulnerable populations.