Risk factors for MDR and XDR-TB in a tertiary referral hospital in India

• Published in: PloS one Vol. 5; no. 3; p. e9527
• Main Authors: Balaji, V, Daley, Peter, Anand, Alok Azad, Sudarsanam, Thambu, Michael, Joy Sarojini, Sahni, Rani Diana, Chordia, Poorvi, George, Ige Abraham, Thomas, Kurien, Ganesh, Alka, John, K R, Mathai, Dilip
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 04.03.2010; Public Library of Science (PLoS)
• Subjects: Acquired immune deficiency syndrome; Adolescent; Adult; AIDS; Antibacterial agents; Antitubercular Agents - therapeutic use; Bivariate analysis; Cavitation; Cavitation resistance; Clinics; Control charts; Cost analysis; Demographics; Drug resistance; Extensively Drug-Resistant Tuberculosis - diagnosis; Extensively Drug-Resistant Tuberculosis - epidemiology; Female; Fluoroquinolones - therapeutic use; Hospitals; Humans; India; Infectious Diseases; Infectious Diseases/Antimicrobials and Drug Resistance; Infectious Diseases/Neglected Tropical Diseases; Laboratories; Male; Medicine; Microbiology/Medical Microbiology; Middle Aged; Multidrug resistant organisms; Multivariate analysis; Mycobacterium tuberculosis; Mycobacterium tuberculosis - metabolism; Patients; Public health; Public Health and Epidemiology/Global Health; Public Health and Epidemiology/Infectious Diseases; Retrospective Studies; Risk; Risk analysis; Risk Factors; Streptomycin; Streptomycin - therapeutic use; Subsidies; Tuberculosis; Tuberculosis, Multidrug-Resistant - diagnosis; Tuberculosis, Multidrug-Resistant - epidemiology; India; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0009527

India has a high burden of drug resistant TB, although there are few data on XDR-TB. Although XDR-TB has existed previously in India, the definition has not been widely applied, and surveillance using second line drug susceptibility testing has not been performed. Our objective was to analyze clinical and demographic risk factors associated with isolation of MDR and XDR TB as compared to susceptible controls, at a tertiary center. Retrospective chart review based on positive cultures isolated in a high volume mycobacteriology laboratory between 2002 and 2007. 47 XDR, 30 MDR and 117 susceptible controls were examined. Drug resistant cases were less likely to be extrapulmonary, and had received more previous treatment regimens. Significant risk factors for XDR-TB included residence outside the local state (OR 7.43, 3.07-18.0) and care costs subsidized (OR 0.23, 0.097-0.54) in bivariate analysis and previous use of a fluoroquinolone and injectable agent (other than streptomycin) (OR 7.00, 95% C.I. 1.14-43.03) and an initial treatment regimen which did not follow national guidelines (OR 5.68, 1.24-25.96) in multivariate analysis. Cavitation and HIV did not influence drug resistance. There is significant selection bias in the sample available. Selection pressure from previous treatment and an inadequate initial regimen increases risk of drug resistance. Local patients and those requiring financial subsidies may be at lower risk of XDR-TB.