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Okumu A, Orwa J, Sitati R, Omondi I, Odhiambo B, Ogoro J, Oballa G, Ochieng B, Wandiga S, Ouma C. Factors associated with tuberculosis drug resistance among presumptive multidrug resistance tuberculosis patients identified in a DRTB surveillance study in western Kenya. J Clin Tuberc Other Mycobact Dis 2024; 37:100466. [PMID: 39188352 PMCID: PMC11345928 DOI: 10.1016/j.jctube.2024.100466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/28/2024] Open
Abstract
Multidrug-resistant tuberculosis (MDR-TB) is caused by M. tuberculosis (Mtb) with resistance to the first-line anti-TB medicines isoniazid (INH) and rifampicin (RIF). In Western Kenya, there is reported low prevalence of drug resistant strains among HIV tuberculosis patients, creating a need to determine factors associated with drug resistance patterns among presumptive MDR-TB patients. To determine factors associated with drug resistance patterns among presumptive MDR-TB patients in western Kenya. Three hundred and ninety (3 9 0) sputum sample isolates from among presumptive multidrug TB patients, were analyzed for TB drug resistance as per Ministry of Health (MoH) TB program diagnostic algorithm. Frequency and percentages were used to summarize categorical data while median and interquartile range (IQR) were used for continuous data. Multivariable logistic regression was carried out to identify factors associated with TB drug resistance. Out of 390 participants enrolled, 302/390 (77.4 %) were males, with a median age of 34 years. The HIV-infected were 118/390 (30.3 %). Samples included 322 (82.6 %) from presumptive patients, while 68/390 (17.4 %) were either lost to follow-up patients, failures to first-line treatment or newly diagnosed cases. A total of 64/390 (16.4 %) of the isolates had at least some form of drug resistance. Out of 390, 14/390 (3.6 %) had MDR, 12 (3.1 %) were RIF mono-resistance, 34 (8.7 %) had INH, while 4 (1 %) had ethambutol resistance. The category of previously treated patients (those who received or are currently on TB treatment) had a 70 % reduced likelihood of resistance (aOR: 0.30; 95 % CI: 0.13-0.70). In contrast, older age was associated with an increased likelihood of resistance to INH and RIF, with an adjusted odds ratio of 1.04 per year (95 % CI: 1.00-1.08). Prompt MDR-TB diagnosis is essential for appropriate patient care, management, and disease prevention and control. We recommend active surveillance on drug resistant TB in these regions to detect drug resistance patterns for rapid disease management.
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Affiliation(s)
- Albert Okumu
- Kenya Medical Research Institute, Centre for Global Health Research, PO Box 1578 -40100, Kisumu, Kenya
- Department of Biomedical Sciences and Technology, Maseno University, PO Box 333-40105, Maseno, Kenya
| | - James Orwa
- The Aga Khan University, Department of Population Health Science, University Center, PO BOX 30270- 00100, Nairobi, Kenya
| | - Ruth Sitati
- Kenya Medical Research Institute, Centre for Global Health Research, PO Box 1578 -40100, Kisumu, Kenya
| | - Isaiah Omondi
- Kenya Medical Research Institute, Centre for Global Health Research, PO Box 1578 -40100, Kisumu, Kenya
| | - Ben Odhiambo
- Kenya Medical Research Institute, Centre for Global Health Research, PO Box 1578 -40100, Kisumu, Kenya
| | - Jeremiah Ogoro
- Ministry of Health, National Leprosy and Tuberculosis Program, NLTP, Afya House Annex, Kenyatta National Hospital, Hospital Road, Nairobi P.O. Box, 30016-00100, Kenya
| | - George Oballa
- Ministry of Health, National Leprosy and Tuberculosis Program, NLTP, Afya House Annex, Kenyatta National Hospital, Hospital Road, Nairobi P.O. Box, 30016-00100, Kenya
| | - Benjamin Ochieng
- Kenya Medical Research Institute, Centre for Global Health Research, PO Box 1578 -40100, Kisumu, Kenya
| | - Steve Wandiga
- Kenya Medical Research Institute, Centre for Global Health Research, PO Box 1578 -40100, Kisumu, Kenya
| | - Collins Ouma
- Department of Biomedical Sciences and Technology, Maseno University, PO Box 333-40105, Maseno, Kenya
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Akalu TY, Clements ACA, Xu Z, Bai L, Alene KA. Determinants of drug-resistant tuberculosis in Hunan province, China: a case-control study. BMC Infect Dis 2024; 24:198. [PMID: 38350860 PMCID: PMC10863170 DOI: 10.1186/s12879-024-09106-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 02/06/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Drug-resistant tuberculosis (DR-TB) is a major public health threat in Hunan Province, with an increasing clinical burden in recent years. This study aimed to identify socio-demographic and clinical factors associated with DR-TB in Hunan province, China. METHODS A case-control study was conducted in Hunan province. Cases were all DR-TB patients who were confirmed by culture and Drug susceptibility testing (DST) and enrolled at the DR-TB treatment center of Hunan Chest Hospital from 2013 to 2018. Controls were all Drug Susceptible TB (DS-TB) patients confirmed by DST and enrolled at the same hospital during the same period. A multivariable logistic regression model was fitted to identify factors significantly associated with DR-TB. RESULTS A total of 17,808 patients (15,534 DS-TB controls and 2274 DR-TB cases) were included in the study, with a mean age of 42.5 years (standard deviation (SD) ± 17.5 years) for cases and 46.1 years (SD ± 19.1 years) for controls. Age 15-64 years (Adjusted odds ratio (AOR = 1.5, 95% CI; 1.4, 1.8)), ethnic minorities (AOR = 1.5; 95% CI; 1.4, 1.8), and a history of previous TB treatment (AOR) = 1.84; 95% CI: 1.57, 2.15) was significantly associated with DR-TB. Being resident in a province outside Hunan was also a significant risk factor (AOR = 1.67; 1.27, 2.21) for DR-TB. CONCLUSION AND RECOMMENDATIONS To prevent the occurrence of DR-TB in Hunan Province, interventions should be targeted at high-risk demographic groups such as ethnic minorities, individuals of productive age, and residents living outside the province. Interventions must also be targeted to previously treated cases, suggesting the appropriateness of diagnosis, treatment, and follow-up. Understanding the risk factors at the province level helps design strategies for controlling DR-TB due to variations by socioeconomic differences, quality of health care, and healthcare access.
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Affiliation(s)
- Temesgen Yihunie Akalu
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia.
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, Western Australia, Australia.
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Archie C A Clements
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, Western Australia, Australia
- Penninsula Medical School, University of Plymouth, Plymouth, UK
| | - Zuhui Xu
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Liqiong Bai
- TB Control Institute of Hunan Province, Changsha, China
| | - Kefyalew Addis Alene
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, Western Australia, Australia
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Puerto GM, Castro CM, Rubio VV, Fadul S, Montes F. Tuberculosis multirresistente en Colombia, 2013-2018: estudio de casos y controles. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2023; 43:447-456. [PMID: 38109144 PMCID: PMC10783159 DOI: 10.7705/biomedica.6842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 10/06/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB) is difficult to control, has high morbidity and mortality, and demands priority public health intervention. In Colombia, MDR/RR-TB has been becoming more widespread annually. Before the COVID-19 pandemic, over an 8-year period, the number of cases of multidrug-resistant tuberculosis in Colombia was close to a thousand cases. Timely identification of the different risk factors for MDR/RR-TB will contribute fundamentally to the systematic management. OBJECTIVE To determine which risk factors were associated with the presentation of MDR in Colombia between 2013 and 2018. MATERIALS AND METHODS A retrospective case-control study was carried out, for which the data from the routine surveillance of MDR/events in the country were used. RESULTS The cases of multidrug-resistant tuberculosis were mainly in young people, Afrodescendants, and males. Of the clinical conditions, comorbidities such as malnutrition, diabetes, and HIV, presence of at least one factor, such as drug dependence, taking immunosuppressive medications, belonging to the black race, afro, and living in an area of high disease burden were risk factors. CONCLUSION In addition to the diagnosis and timely provision of MDR-TB treatment, it is necessary that public health programs at the local level pay special attention to patients with the identified risk factors.
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Affiliation(s)
- Gloria Mercedes Puerto
- Grupo Micobacterias, RED TB COLOMBIA, Dirección de Investigación en Salud Pública, Instituto Nacional de Salud, Bogotá, D. C., Colombia.
| | - Claudia Marcela Castro
- Equipo Banco de Proyectos, RED TB COLOMBIA, Dirección de Investigación en Salud Pública, Instituto Nacional de Salud, Bogotá, D. C., Colombia.
| | - Vivian Vanesa Rubio
- Grupo Micobacterias, RED TB COLOMBIA, Dirección de Investigación en Salud Pública, Instituto Nacional de Salud, Bogotá, D. C., Colombia.
| | - Santiago Fadul
- Grupo Micobacterias, RED TB COLOMBIA, Dirección de Vigilancia y Análisis del Riesgo en Salud Pública, Instituto Nacional de Salud, Bogotá, D. C., Colombia.
| | - Fernando Montes
- Programa de Tuberculosis, RED TB COLOMBIA, Secretaría de Salud de Medellín, Colombia.
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Rehman AU, Khattak M, Mushtaq U, Latif M, Ahmad I, Rasool MF, Shakeel S, Hayat K, Hussain R, Alhazmi GA, Alshomrani AO, Alalawi MI, Alghamdi S, Imam MT, Almarzoky Abuhussain SS, Khayyat SM, Haseeb A. The impact of diabetes mellitus on the emergence of multi-drug resistant tuberculosis and treatment failure in TB-diabetes comorbid patients: a systematic review and meta-analysis. Front Public Health 2023; 11:1244450. [PMID: 38074769 PMCID: PMC10704033 DOI: 10.3389/fpubh.2023.1244450] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/24/2023] [Indexed: 12/18/2023] Open
Abstract
Background The existence of Type 2 Diabetes Mellitus (DM) in tuberculosis (TB) patients is very dangerous for the health of patients. One of the major concerns is the emergence of MDR-TB in such patients. It is suspected that the development of MDR-TB further worsens the treatment outcomes of TB such as treatment failure and thus, causes disease progression. Aim To investigate the impact of DM on the Emergence of MDR-TB and Treatment Failure in TB-DM comorbid patients. Methodology The PubMed database was systematically searched until April 03, 2022 (date last searched). Thirty studies met the inclusion criteria and were included in this study after a proper selection process. Results Tuberculosis-Diabetes Mellitus patients were at higher risk to develop MDR-TB as compared to TB-non-DM patients (HR 0.81, 95% CI: 0.60-0.96, p < 0.001). Heterogeneity observed among included studies was moderate (I2 = 38%). No significant change was observed in the results after sub-group analysis by study design (HR 0.81, 95% CI: 0.61-0.96, p < 0.000). In the case of treatment failure, TB-DM patients were at higher risk to experience treatment failure rates as compared to TB-non-DM patients (HR 0.46, 95% CI: 0.27-0.67, p < 0.001). Conclusion The results showed that DM had a significant impact on the emergence of MDR-TB in TB-diabetes comorbid patients as compared to TB-non-DM patients. DM enhanced the risk of TB treatment failure rates in TB-diabetes patients as compared to TB-non-DM patients. Our study highlights the need for earlier screening of MDR-TB, thorough MDR-TB monitoring, and designing proper and effective treatment strategies to prevent disease progression.
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Affiliation(s)
- Anees ur Rehman
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Mahnoor Khattak
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Usman Mushtaq
- Nishter Medical University and Hospital, Multan, Pakistan
| | - Muhammad Latif
- Department of Zoology, Division of Science and Technology, University of Education Lahore, Lahore, Pakistan
| | - Imran Ahmad
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Muhammad Fawad Rasool
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Sadia Shakeel
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Dow University of Health Sciences, Karachi, Pakistan
| | - Khezar Hayat
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Rabia Hussain
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Ghaidaa Ali Alhazmi
- Department of Pharmacy, King Abdullah Medical City, Ministry of Health, Makkah, Saudi Arabia
| | - Afnan Owedah Alshomrani
- Pharmaceutical Care Department, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Jeddah, Saudi Arabia
| | | | - Saleh Alghamdi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Al-Baha University, Al-Baha, Saudi Arabia
| | - Mohammad Tarique Imam
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
| | | | - Sarah M. Khayyat
- Department of Pharmacy Practice, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Abdul Haseeb
- Department of Pharmacy Practice, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
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Vyawahare C, Mukhida S, Khan S, Gandham NR, Kannuri S, Bhaumik S. Assessment of risk factors associated with drug-resistant tuberculosis in pulmonary tuberculosis patients. Indian J Tuberc 2023; 71 Suppl 1:S44-S51. [PMID: 39067954 DOI: 10.1016/j.ijtb.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/10/2023] [Accepted: 07/24/2023] [Indexed: 07/30/2024]
Abstract
INTRODUCTION Tuberculosis remains a global health problem worldwide and the risk progression of Tuberculosis to Drug Resistant Tuberculosis is influenced by various factors. These include immunocompromised status, past history of tuberculosis, life style and nutritional level. Hence, identifying the population at risk of multidrug-resistant tuberculosis is essential and may help in developing appropriate case-finding strategies. Therefore, the present study was designed to study the contributing risk-factors associated with Drug resistant Tuberculosis. MATERIALS AND METHODS In this prospective observational study, we assessed 189 Pulmonary tuberculosis diagnosed patients during the period of 2 years at government recognized tertiary care centers. Data was collected from all these patients checked to investigate risk factors associated with Drug resistant tuberculosis development by multivariant analysis. RESULTS Of the 189 participants, 36 were diagnosed with drug resistant tuberculosis and 153 with drug sensitive tuberculosis. Factors associated with drug resistant tuberculosis include low-weight (OR 8.50; p = 0.0008430991), low-BMI (p = 0.0000527166), lower economic status (OR-2.1351; p = 0.048608696) and tobacco (OR-4.5192; p = 0.0023003189) were found clinically and statistically significant in development of drug resistant tuberculosis. Binary logistic regression was performed to ascertain the effects of various statistically significant factors. Drug resistant tuberculosis patients were 7.77 times more likely to be tobacco users than drug sensitive tuberculosis. CONCLUSIONS Our study suggests that, there is a compelling and urgent need for increasing public awareness, initiating better nutrition and food programs, regular screening, and better management & control of MDR-TB.
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Affiliation(s)
- Chanda Vyawahare
- Department of Microbiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, 411018, India
| | - Sahjid Mukhida
- Department of Microbiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, 411018, India.
| | - Sameena Khan
- Department of Microbiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, 411018, India
| | - Nageswari R Gandham
- Department of Microbiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, 411018, India
| | - Sriram Kannuri
- Department of Microbiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, 411018, India
| | - Shalini Bhaumik
- Department of Microbiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, 411018, India
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Park J, Hong Y, Hong JY. Risk for multidrug-resistant tuberculosis in patients treated with anti-tumor necrosis factor agents. Front Med (Lausanne) 2023; 10:1108119. [PMID: 37035321 PMCID: PMC10073508 DOI: 10.3389/fmed.2023.1108119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 03/06/2023] [Indexed: 04/11/2023] Open
Abstract
Background There are few studies on medical conditions associated with the development of drug-resistant TB. Objective We investigated the risk factors for the occurrence of multidrug-resistant (MDR) tuberculosis (TB) in patients with pulmonary TB. Materials and methods Based on claims data from the Health Insurance Review and Assessment service in South Korea, we retrospectively investigated patients aged 18 years or older with active pulmonary TB who were treated with anti-TB therapy between January 1, 2008, and February 28, 2021. Results Among 248,176 patients with pulmonary TB who underwent anti-TB therapy, 2.0% were identified as having MDR-TB. MDR-TB showed male predominance compared to patients without MDR-TB, and patients with MDR-TB were younger. The risk for MDR-TB in patients treated with anti-TB therapy was 3.26 times higher in patients who received anti-tumor necrosis factor (TNF) agents before prescription of anti-TB medications than in those who had never been exposed to anti-TNF agents after adjusting for other TB risk factors (age, sex, inhaled corticosteroid, diabetes mellitus, liver disease, pneumoconiosis, and organ or blood recipients). The risk for MDR-TB was also increased in males and younger patients. Conclusion Treatment with an anti-TNF agent could be a driver of MDR-TB in patients with pulmonary TB.
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Affiliation(s)
- Jinkyeong Park
- Department of Pulmonary, Allergy and Critical Care Medicine, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Yoonki Hong
- Department of Internal Medicine, School of Medicine, Kangwon National University, Kangwon National University Hospital, Chuncheon, Republic of Korea
| | - Ji Young Hong
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Hallym University Medical Center, Chuncheon, Gangwon-do, Republic of Korea
- *Correspondence: Ji Young Hong,
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You S, Chitwood MH, Gunasekera KS, Crudu V, Codreanu A, Ciobanu N, Furin J, Cohen T, Warren JL, Yaesoubi R. Predicting resistance to fluoroquinolones among patients with rifampicin-resistant tuberculosis using machine learning methods. PLOS DIGITAL HEALTH 2022; 1:e0000059. [PMID: 36177394 PMCID: PMC9518704 DOI: 10.1371/journal.pdig.0000059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 05/09/2022] [Indexed: 11/24/2022]
Abstract
Background Limited access to drug-susceptibility tests (DSTs) and delays in receiving DST results are challenges for timely and appropriate treatment of multi-drug resistant tuberculosis (TB) in many low-resource settings. We investigated whether data collected as part of routine, national TB surveillance could be used to develop predictive models to identify additional resistance to fluoroquinolones (FLQs), a critical second-line class of anti-TB agents, at the time of diagnosis with rifampin-resistant TB. Methods and findings We assessed three machine learning-based models (logistic regression, neural network, and random forest) using information from 540 patients with rifampicin-resistant TB, diagnosed using Xpert MTB/RIF and notified in the Republic of Moldova between January 2018 and December 2019. The models were trained to predict the resistance to FLQs based on demographic and TB clinical information of patients and the estimated district-level prevalence of resistance to FLQs. We compared these models based on the optimism-corrected area under the receiver operating characteristic curve (OC-AUC-ROC). The OC-AUC-ROC of all models were statistically greater than 0.5. The neural network model, which utilizes twelve features, performed best and had an estimated OC-AUC-ROC of 0.87 (0.83,0.91), which suggests reasonable discriminatory power. A limitation of our study is that our models are based only on data from the Republic of Moldova and since not externally validated, the generalizability of these models to other populations remains unknown. Conclusions Models trained on data from phenotypic surveillance of drug-resistant TB can predict resistance to FLQs based on patient characteristics at the time of diagnosis with rifampin-resistant TB using Xpert MTB/RIF, and information about the local prevalence of resistance to FLQs. These models may be useful for informing the selection of antibiotics while awaiting results of DSTs.
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Affiliation(s)
- Shiying You
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, United States of America
- Public Health Modeling Unit, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Melanie H. Chitwood
- Public Health Modeling Unit, Yale School of Public Health, New Haven, Connecticut, United States of America
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Kenneth S. Gunasekera
- Public Health Modeling Unit, Yale School of Public Health, New Haven, Connecticut, United States of America
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Valeriu Crudu
- Phthisiopneumology Institute, Chisinau, Republic of Moldova
| | | | - Nelly Ciobanu
- Phthisiopneumology Institute, Chisinau, Republic of Moldova
| | - Jennifer Furin
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio, United States of America
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ted Cohen
- Public Health Modeling Unit, Yale School of Public Health, New Haven, Connecticut, United States of America
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Joshua L. Warren
- Public Health Modeling Unit, Yale School of Public Health, New Haven, Connecticut, United States of America
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Reza Yaesoubi
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, United States of America
- Public Health Modeling Unit, Yale School of Public Health, New Haven, Connecticut, United States of America
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Marua AM, Shethwala ND, Bhatt P, Shah A. Evaluation of Bacterial Co-Infections and Antibiotic Resistance in Positive COVID-19 Patients. MAEDICA 2022; 17:350-356. [PMID: 36032617 PMCID: PMC9375886 DOI: 10.26574/maedica.2022.17.2.350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Aim: Due to the fact that patients with COVID--19 can have a bacterial co-infection, physicians should be careful when prescribing antibiotics, with rather considering the sensitivity and resistance of these drugs than various bacteria. Therefore, the main purpose of the present study was to evaluate bacterial coinfections and antibiotic resistance in positive COVID-19 patients. Method:This descriptive cross-sectional study was performed on 450 hospitalized COVID-19 patients who were selected by simple random sampling. Blood culture (BC) and endotracheal aspirate (ETA) were performed for all COVID-19 patients participating in the study. Antibacterial susceptibility was assessed using the standard Kirby-Bauer disk diffusion method on Mueller Hinton agar for all isolated strains in accordance with the Institute of Clinical and Laboratory Standards guidelines. Finally, susceptibility of all identified bacteria to 10 types of antibiotics was assessed. Results:Based on the results of endotracheal aspirate (ETA) culture, we found that 79 (17.5%) patients had COVID-19 and bacterial co-infection. Among COVID-19 patients with bacterial co-infection, Klebsiella species had the highest frequency (21.6%), followed by Methicillin-sensitive Staphylococcus aureus (MSSA) (19%), Escherichia coli (17.7%), Methicillin-resistant Staphylococcus aureus (MRSA) (15.2%), Enterobacter species (13.9%) and Pseudomonas aeruginosa (12.6%), respectively. Based on the results of the present study, it was found that the level of antibiotic resistance for different bacteria varied from 0-100%. Conclusion:The results of the present study indicate that patients with COVID-19 are susceptible to bacterial co-infection, which leads to the conclusion that excessive use of antibiotics is an important factor in the development of antimicrobial resistance. Therefore, caution is needed in prescribing different antibiotics to patients with COVID-19. In addition, considering the SARS-CoV-2 co-infection with other pathogens, it is necessary to use an optimal treatment method for this purpose.
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Affiliation(s)
- Alpesh M Marua
- Department of Pathology, Dr. N. D. Desai Faculty of Medical Science and Research, Nadiad, India
| | | | - Parth Bhatt
- Department of Pathology, Dr. N. D. Desai Faculty of Medical Science and Research, Dharmsinh Desai University, Nadiad, India
| | - Amar Shah
- Department of Pathology, Dr. N. D. Desai Faculty of Medical Science and Research, Dharmsinh Desai University, Nadiad, India
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Sheuly AH, Arefin SMZH, Barua L, Zaman MS, Chowdhury HA. Prevalence of type 2 diabetes and pre‐diabetes among pulmonary and extrapulmonary tuberculosis patients of Bangladesh: A cross‐sectional study. Endocrinol Diabetes Metab 2022; 5:e00334. [PMID: 35261187 PMCID: PMC9094490 DOI: 10.1002/edm2.334] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/02/2022] [Accepted: 02/26/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- Afsana Habib Sheuly
- Helen Keller International Bangladesh Dhaka Bangladesh
- Department of Biostatistics Bangladesh University of Health Sciences (BUHS) Dhaka Bangladesh
| | | | - Lingkan Barua
- Department of Noncommunicable Diseases Bangladesh University of Health Sciences (BUHS) Dhaka Bangladesh
| | | | - Hasina Akhter Chowdhury
- Department of Biostatistics Bangladesh University of Health Sciences (BUHS) Dhaka Bangladesh
- Centre for Injury Prevention and Research Bangladesh Dhaka Bangladesh
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Gautam S, Shrestha N, Mahato S, Nguyen TPA, Mishra SR, Berg-Beckhoff G. Diabetes among tuberculosis patients and its impact on tuberculosis treatment in South Asia: a systematic review and meta-analysis. Sci Rep 2021; 11:2113. [PMID: 33483542 PMCID: PMC7822911 DOI: 10.1038/s41598-021-81057-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/18/2020] [Indexed: 01/30/2023] Open
Abstract
The escalating burden of diabetes is increasing the risk of contracting tuberculosis (TB) and has a pervasive impact on TB treatment outcomes. Therefore, we conducted this systematic review and meta-analysis to examine the burden of diabetes among TB patients and assess its impact on TB treatment in South Asia (Afghanistan, Bangladesh, Bhutan, Maldives, Nepal, India, Pakistan, and Sri Lanka). PubMed, Excerpta Medica Database (EMBASE), and CINAHL databases were systematically searched for observational (cross-sectional, case-control and cohort) studies that reported prevalence of diabetes in TB patients and published between 1 January 1980 and 30 July 2020. A random-effect model for computing the pooled prevalence of diabetes and a fixed-effect model for assessing its impact on TB treatment were used. The review was registered with PROSPERO number CRD42020167896. Of the 3463 identified studies, a total of 74 studies (47 studies from India, 10 from Pakistan, four from Nepal and two from both Bangladesh and Sri-Lanka) were included in this systematic review: 65 studies for the prevalence of diabetes among TB patients and nine studies for the impact of diabetes on TB treatment outcomes. The pooled prevalence of diabetes in TB patients was 21% (95% CI 18.0, 23.0; I2 98.3%), varying from 11% in Bangladesh to 24% in Sri-Lanka. The prevalence was higher in studies having a sample size less than 300 (23%, 95% CI 18.0, 27.0), studies conducted in adults (21%, 95% CI 18.0, 23.0) and countries with high TB burden (21%, 95% CI 19.0, 24.0). Publication bias was detected based on the graphic asymmetry of the funnel plot and Egger's test (p < 0.001). Compared with non-diabetic TB patients, patients with TB and diabetes were associated with higher odds of mortality (Odds Ratio (OR) 1.7; 95% CI 1.2, 2.51; I2 19.4%) and treatment failure (OR 1.7; 95% CI 1.1, 2.4; I2 49.6%), but not associated with Multi-drug resistant TB (OR 1.0; 95% CI 0.6, 1.7; I2 40.7%). This study found a high burden of diabetes among TB patients in South Asia. Patients with TB-diabetes were at higher risk of treatment failure and mortality compared to TB alone. Screening for diabetes among TB patients along with planning and implementation of preventive and curative strategies for both TB and diabetes are urgently needed.
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Affiliation(s)
- Sanju Gautam
- Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | | | - Sweta Mahato
- Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Tuan P A Nguyen
- Faculty of Health Science, University of Southern Denmark, Odense, Denmark
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11
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Oyedeji GJ, Adeyemo C, Dissou A, Abiodun T, Alli OAT, Onaolapo OJ, Onaolapo AY, Adesiji Y, Olowe OA. Prevalence of Multi-Drug Resistant Tuberculosis among Tuberculosis Patients Attending Chest Clinics in Osun-State, Nigeria. Curr Pharm Biotechnol 2020; 21:939-947. [PMID: 32101120 DOI: 10.2174/1389201021666200226100242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 12/15/2019] [Accepted: 02/09/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND The development of multidrug-resistant tuberculosis (MDR-TB) poses a considerable threat to tuberculosis control programmes in Nigeria. There is an increase in the prevalence of MDR-TB worldwide both among new tuberculosis cases as well as previously-treated ones. There is also a rise in transmission of resistant strains due to an increase in MDR-TB patients largely due to the poor drug compliance and the impact of Human immunodeficiency virus infection. Therefore, we intend to determine the extent of MDR-TB among attendees of chest clinics in Osun-State, Nigeria. OBJECTIVES The objective of this study was to determine the prevalence of MDR-TB among confirmed tuberculosis patients attending chest clinics in Osun-State, Nigeria. METHODS This study was conducted among 207 attendees of chest clinics in Osun-State between June, 2015 and October 15, 2016. Sputum and blood samples of the participants were collected. GeneXpert test was carried out first on the samples for simultaneous identification of MTB and rifampicin resistance. Sputum samples were cultured on Lowenstein-Jensen (L-J) medium using N-acetyl-Lcysteine- sodium hydroxide (NALC-NaOH) decontamination method. Drug susceptibility testing (DST) to three first-line drugs was carried out using the proportion DST method. RESULTS The prevalence of MTB was found to be 27.5% while the prevalence of MDR-TB from the fifty-seven isolates was 10.5%. Previously treated and new cases had a prevalence of 7.0% and 3.5% MDR-TB, respectively. Seventy (33.8%) participants were positive for HIV infection, out of which twenty-six (12.6%) had co-infection of tuberculosis and HIV. The mono-resistance rates of the three first-line drugs used were: 5.3% and 8.7% for ethambutol (EMB) and isoniazid (INH), respectively. No isolate had mono-resistance (0%) to rifampicin (RIF). CONCLUSION This study observed the prevalence of 27.5% MTB and a prevalence of 10.5% MDR-TB among the MTB isolates. The prevalence of TB is high in Osun State. MDR-TB prevalence is higher compared with the national estimate of MDR-TB (5.1%) of 2017. Resistant TB is a threat to national tuberculosis control and it is recommended that all the facilities be equipped to cater to its diagnosis.
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Affiliation(s)
- Gbadebo J Oyedeji
- Department of Medical Microbiology and Parasitology, Faculty of Basic Medical Sciences, Ladoke Akintola University of Technology, P.M.B. 4400 Osogbo, Nigeria
| | | | - Affolabi Dissou
- Laboratoire de Référence des Mycobactéries (LRM) Cotonou, Benin
| | - Tope Abiodun
- Nigeria Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Oyebode A T Alli
- Department of Medical Laboratory Science, Faculty of Basic Medical Sci-ences, Ladoke Akintola University of Technology, P.M.B. 4400 Osogbo, Nigeria
| | - Olakunle J Onaolapo
- Department of Pharmacology and Therapeutics, Faculty of Basic Medical Sciences, Ladoke Akintola University of Technology, P.M.B. 4400 Osogbo, Nigeria
| | - Adejoke Y Onaolapo
- Department of Anatomy, Faculty of Basic Medical Sciences, Ladoke Akintola University of Technology, P.M.B. 4000 Ogbomoso, Nigeria
| | - Yemisi Adesiji
- Department of Medical Microbiology and Parasitology, Faculty of Basic Medical Sciences, Ladoke Akintola University of Technology, P.M.B. 4400 Osogbo, Nigeria
| | - Olugbenga A Olowe
- Department of Medical Microbiology and Parasitology, Faculty of Basic Medical Sciences, Ladoke Akintola University of Technology, P.M.B. 4400 Osogbo, Nigeria
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Tenzin C, Chansatitporn N, Dendup T, Dorji T, Lhazeen K, Tshering D, Pelzang T. Factors associated with multidrug-resistant tuberculosis (MDR-TB) in Bhutan: A nationwide case-control study. PLoS One 2020; 15:e0236250. [PMID: 32716965 PMCID: PMC7384628 DOI: 10.1371/journal.pone.0236250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 07/01/2020] [Indexed: 12/02/2022] Open
Abstract
Background Multidrug-resistant tuberculosis (MDR-TB) is a growing public health concern globally. In Bhutan, the rates of MDR-TB are high. Data on the risk factors of MDR-TB that can help inform policies are limited in Bhutan. This study aimed to determine the risk factors associated with MDR-TB. Methods A nationwide unmatched case-control study was conducted that included 79 MDR-TB cases and 118 controls. Data was collected by trained health workers through interviews using a structured questionnaire. Logistic regression analysis was performed to identify the risk factors associated with MDR-TB. Results The mean age of the participants was 32.4 and 33.7 years among the cases and the controls, respectively. In the multivariate analysis, the odds of having MDR-TB was higher among those who slept for less than 9 hours a day (AOR: 2.77, 95%CI: 1.11–6.92), frequently travelled in public transport (AOR: 2.96, 95% CI: 1.36–6.48), and had previous TB treatment (AOR: 5.90, 95%CI: 2.55–13.64). A greater number of rooms was also marginally associated with odds of having MDR-TB. Conclusions The findings suggest previous TB treatment, inadequate sleep duration, and travelling by public transport to be the risk factors associated with having MDR-TB in Bhutan. Intensification of early case detection, strengthening directly observed treatment strategy, improving treatment adherence, and increasing awareness can help control the rising MDR-TB epidemic.
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Affiliation(s)
- Chador Tenzin
- Bumthang General Hospital, Ministry of Health, Royal Government of Bhutan, Bumthang, Bhutan
- Department of Biostatistics, Faculty of Public Health, Mahidol University, Bangkok, Thailand
- * E-mail:
| | - Natkamol Chansatitporn
- Department of Biostatistics, Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - Tashi Dendup
- School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, NSW, Australia
| | - Tandin Dorji
- Department of Medical Services, Ministry of Health, Royal Government of Bhutan, Kawangjangsa, Thimphu, Bhutan
| | - Karma Lhazeen
- Department of Public Health, Ministry of Health, Royal Government of Bhutan, Kawangjangsa, Thimphu, Bhutan
| | - Dorji Tshering
- Central Regional Referral Hospital, Ministry of Health, Royal Government of Bhutan, Gelephu, Bhutan
| | - Thinley Pelzang
- Phuentsholing General Hospital, Ministry of Health, Royal Government of Bhutan, Phuentsholing, Bhutan
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13
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Sharma N, Bhatnagar A, Basu S, Khanna A, Chopra KK, Banerjee B, Sharma N, Chandra S, Khanna V, Arora R, Babbar N. A comparison of patient treatment pathways among multidrug-resistant and drug-sensitive TB cases in Delhi, India: A cross-sectional study. Indian J Tuberc 2020; 67:502-508. [PMID: 33077051 DOI: 10.1016/j.ijtb.2020.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The delay in the diagnosis and treatment initiation of patients with MDR-TB worsens individual prognosis and increases the risk of disease transmission in the community. These delays have been attributed to delay in treatment-seeking by the patient and shifting to multiple healthcare facilities before being tested and diagnosed through India's National Tuberculosis Elimination Program (NTEP). OBJECTIVE to identify treatment pathways in patients with MDR-TB from the time of onset of symptoms and treatment seeking until diagnosis at a PMDT site and subsequent treatment initiation. We also compared these characteristics with those of patients with DS-TB. METHODS We recruited a total of 168 patients with MDR-TB and DS-TB each, in Delhi. Data were analyzed using IBM SPSS Version 25. RESULTS The mean (SD) patient delay for initial treatment-seeking was 20.9 (15.9) days in patients with MDR-TB, and 16.1 (17.1) days in patients with DS-TB (p < 0.001). The median time from visit to the first healthcare facility (HCF) until confirmation of MDR-TB diagnosis was 78.5 days, and until treatment initiation was 102.5 days. Among patients with DS-TB, the time interval from a visit to the first HCF until the initiation of ATT-DOTS was 61.5 days.. Patients diagnosed with DS-TB, whose first source of treatment was a private facility (n = 49), reported a significant delay in the initiation of ATT-DOTS (p < 0.001). CONCLUSIONS Despite the introduction of universal drug sensitivity testing in individuals having presumptive MDR-TB, a significant delay in the diagnosis and initiation of effective MDR-TB treatment persists as a major public health challenge in India.
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Affiliation(s)
- Nandini Sharma
- Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
| | | | - Saurav Basu
- Department of Community Medicine, Maulana Azad Medical College, New Delhi, India.
| | | | | | - Bratati Banerjee
- Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
| | - Neha Sharma
- Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
| | - Shivani Chandra
- WHO, RNTCP Medical Consultant, Office of WHO Representative to India, New Delhi, India
| | | | - Reema Arora
- Medical Officer, RNTCP, Lok Nayak Hospital, New Delhi, India
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Charoensakulchai S, Limsakul M, Saengungsumalee I, Usawachoke S, Udomdech A, Pongsaboripat A, Kaewput W, Sakboonyarat B, Rangsin R, Suwannahitatorn P, Mungthin M, Piyaraj P. Characteristics of Poor Tuberculosis Treatment Outcomes among Patients with Pulmonary Tuberculosis in Community Hospitals of Thailand. Am J Trop Med Hyg 2020; 102:553-561. [PMID: 31933460 DOI: 10.4269/ajtmh.19-0564] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Pulmonary tuberculosis (TB) is a major global public health problem. Thailand is listed as one of the countries with a high burden of pulmonary TB. Various factors are known to contribute to unsuccessful pulmonary TB treatment. However, studies in Thailand remain limited, especially in rural settings. This study aimed to identify the prevalence and associated factors of unsuccessful pulmonary TB treatment in community hospitals. A cross-sectional study was conducted from June-July 2019. We enrolled all patients receiving treatments in four community hospitals in central Thailand. The collected data included baseline characteristics, comorbid illnesses, a history of directly observed treatment-short course (DOTS), sputum acid-fast bacilli smear results, and chest radiography and treatment outcomes. Univariate and multivariate analyses were used to identify factors associated with unsuccessful pulmonary TB treatment. A total of 786 patients were enrolled in the study. Prevalence of unsuccessful treatment was 18.7%. Associated factors of unsuccessful pulmonary TB treatment were previously treated TB (adjusted odds ratio [AOR]: 2.1, 95% CI: 1.2-3.7), existence of comorbid illnesses (AOR: 2.8, 95% CI: 1.5-5.0), DOTS not performed (AOR: 2.5, 95% CI: 1.4-4.5), chest radiography showing multiple lung lesions at first diagnosis (AOR: 3.0, 95% CI: 1.7-5.2), no chest radiography improvement in the first follow-up (AOR: 17.7, 95% CI: 8.2-38.0), and unknown status of chest radiography in the first follow-up (AOR: 48.1, 95% CI: 22.3-103.5). Health promotion and primary care should be implemented in the communities to achieve ultimate successful treatment.
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Affiliation(s)
| | | | | | | | | | | | - Wisit Kaewput
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Boonsub Sakboonyarat
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Ram Rangsin
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
| | | | - Mathirut Mungthin
- Department of Pharmacology, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Phunlerd Piyaraj
- Department of Parasitology, Phramongkutklao College of Medicine, Bangkok, Thailand
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15
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Christopher PM, Widysanto A. GeneXpert Mycobacterium tuberculosis/rifampicin assay for molecular epidemiology of rifampicin-Resistant Mycobacterium tuberculosis in an Urban Setting of Banten province, Indonesia. Int J Mycobacteriol 2020; 8:351-358. [PMID: 31793505 DOI: 10.4103/ijmy.ijmy_138_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Tuberculosis (TB) is the fourth leading cause of death in Indonesia. In 2017, the World Health Organization (WHO) estimated that only 2% of the TB patients in Indonesia had only been tested with rapid diagnostics at the time of diagnosis, resulting in largely underdetected rifampicin-resistant TB (RR-TB). Utilization of GeneXpert Mycobacterium tuberculosis/rifampicin (MTB/RIF) assay as a point-of-care molecular assay to detect TB and RR-TB and serving its purpose in accordance with the first pillar of the WHO End-TB Strategy. Objective This study investigated the use of GeneXpert MTB/RIF assay to determine the molecular epidemiology of RR-TB in an urban setting of Indonesia. Methods All molecular epidemiological and microbiological databases were retrospectively examined from GeneXpert MTB/RIF assay results in Siloam Hospital Lippo Village. The sociodemographic characteristics and results of microbiological examinations consisting of Ziehl-Neelsen staining and GeneXpert MTB/RIF assay were analyzed. Results During the study period, 600 cases were registered, and GeneXpert MTB/RIF tests were done in which the tests yielded 597 (99.5%) valid results; 62.0% were male and adult of age category; of whom 29 samples (4.9%) were found to be RR-TB, 186 samples (31.2%) were RIF sensitive, and remainders were negative. Conclusions The results of GeneXpert MTB/RIF to be a fundamental diagnosis of RR-TB and subsequently to notify MDR-TB were satisfying and valuable in this study. This further increased and reinforced TB surveillance and national TB program to finally bring about WHO end-TB strategy one step closer in Indonesia.
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Affiliation(s)
- Paulus Mario Christopher
- Department of Microbiology, Faculty of Medicine, Pelita Harapan University, Tangerang, Banten, Indonesia
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- Department of Microbiology, Faculty of Medicine, Pelita Harapan University, Tangerang, Banten, Indonesia
| | - Allen Widysanto
- Department of Respirology, Faculty of Medicine, Pelita Harapan University, Tangerang, Banten, Indonesia
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Campelo TA, Lima LNC, Lima KVB, Silva CS, da Conceição ML, Barreto JAP, Mota APP, Sancho SDO, Frota CC. Molecular characterization of pre-extensive drug resistant Mycobacterium tuberculosis in Northeast Brazil. Rev Inst Med Trop Sao Paulo 2020; 62:e4. [PMID: 32049255 PMCID: PMC7014566 DOI: 10.1590/s1678-9946202062004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 10/14/2019] [Indexed: 12/19/2022] Open
Abstract
In Fortaleza, the capital of Ceara State, Brazil, the detection rate of tuberculosis (TB) in 2018 was 65.5/100,000 inhabitants with a cure rate of 59.1%, which is higher than the country average. This study investigated the risk factors associated with drug-resistant tuberculosis (DR-TB) and identified the drug-resistance phenotype and resistance-conferring mutations. The geographic distribution of DR-TB in Fortaleza, Brazil, was also determined. From March 2017 to February 2018, 41 DR-TB isolates and 69 drug-susceptible pulmonary TB isolates were obtained from patients seen at a referral hospital in Fortaleza, Brazil. Samples were subjected to phenotypic and genetic analysis of resistance; the spatial distribution of the participants was also analyzed. Primary resistance was high (50.9%) among participants. The following risk factors for DR were identified: being female ( p = 0.03), having diabetes ( p < 0.01), history of previous TB disease ( p < 0.01), and the number of intra-domiciliary contacts ( p < 0.01). Analysis by multiplex allele-specific polymerase chain reaction detected mutations in the genes katG (65.8%) , rpoB (43.9%), inhA promoter (14.6%), and gyrA (9.8%). Sequencing identified mutations in the the genes katG (75.6%), inhA promoter (19.5%), rpoB (85.4%), and gyrA (100%). There was no mutation in the rrs gene. Spatial analysis showed DR-TB isolates distributed in areas of low socioeconomic status in the city of Fortaleza. Our results emphasized the importance of detecting resistance to TB drugs. The resistance found in the gene gyrA is of concern due to the high number of pre-extensive DR-TB cases in Fortaleza.
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Affiliation(s)
- Thales Alves Campelo
- Universidade Federal do Ceará , Faculdade de Medicina, Departamento de Patologia e Medicina Legal , Fortaleza , Ceará , Brazil
| | - Luana Nepomuceno Costa Lima
- Instituto Evandro Chagas , Seção de Bacteriologia e Micologia, Ananindeua , Pará , Brazil
- Universidade do Estado do Pará , Programa de Pós-Graduação em Biologia Parasitária na Amazônia , Belém , Pará , Brazil
| | - Karla Valéria Batista Lima
- Instituto Evandro Chagas , Seção de Bacteriologia e Micologia, Ananindeua , Pará , Brazil
- Universidade do Estado do Pará , Programa de Pós-Graduação em Biologia Parasitária na Amazônia , Belém , Pará , Brazil
| | - Caroliny Soares Silva
- Universidade Federal do Ceará , Faculdade de Medicina, Departamento de Patologia e Medicina Legal , Fortaleza , Ceará , Brazil
| | - Marília Lima da Conceição
- Universidade do Estado do Pará , Programa de Pós-Graduação em Biologia Parasitária na Amazônia , Belém , Pará , Brazil
| | | | - Aquiles Paulino Peres Mota
- Universidade Federal do Ceará , Faculdade de Medicina, Departamento de Patologia e Medicina Legal , Fortaleza , Ceará , Brazil
| | - Soraya de Oliveira Sancho
- Universidade Federal do Ceará , Faculdade de Medicina, Departamento de Patologia e Medicina Legal , Fortaleza , Ceará , Brazil
| | - Cristiane Cunha Frota
- Universidade Federal do Ceará , Faculdade de Medicina, Departamento de Patologia e Medicina Legal , Fortaleza , Ceará , Brazil
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Wu X, Yang J, Tan G, Liu H, Liu Y, Guo Y, Gao R, Wan B, Yu F. Drug Resistance Characteristics of Mycobacterium tuberculosis Isolates From Patients With Tuberculosis to 12 Antituberculous Drugs in China. Front Cell Infect Microbiol 2019; 9:345. [PMID: 31828045 PMCID: PMC6849330 DOI: 10.3389/fcimb.2019.00345] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 09/25/2019] [Indexed: 11/29/2022] Open
Abstract
Objective: To investigate the drug resistance characteristics of Mycobacterium tuberculosis (MTB) isolates from patients with tuberculosis to 12 antituberculous drugs in China. Methods: All clinical isolates of MTB were isolated from patients with tuberculosis in Shanghai Pulmonary Hospital (SPH) during the period from January 1st to December 31th, 2018. Drug susceptibility testing (DST) was performed in micro plates with 12 antituberculous drugs in accordance with relevant guideline. Demographic information, including sex, age, and treatment history was recorded. Results: A total of 1,950 MTB isolates were included in this retrospective study which were isolated from 1,950 patients from 29 regions in China. One thousand six hundred and forty-four were initial treated and 306 were re-treated in the hospital. Two hundred and eight (10.67%, 208/1,950) cases were diagnosed as multidrug-resistant tuberculosis (MDR-TB), from which 74 (4.50%, 74/1,644) cases were initial treated, and the remaining (43.79%, 134/306) were re-treated cases. Besides, the percentage of extensively drug-resistant tuberculosis (XDR-TB) varied in such 3 different groups: 1.64% (32/1,950) in total cases, 0.30% (5/1,644) in initial treated cases and 8.82% (27/306) in re-treated cases. The total resistance rates were as follows: isoniazid (361, 18.51%), streptomycin (302, 15.49%), rifampin (241, 12.36%), ofloxacin (239, 12.26%), moxifloxacin (232, 11.90%), rifabutin (195, 10.00%), ethambutol (100, 5.13%), cycloserine (55, 2.82%), kanamycin (48, 2.46%), ethionamide (40, 2.05%), amikacin (39, 2.00%), and aminosalicylic acid (21, 1.08%). Rates of resistance to any drug in re-treated cases were significantly higher than in initial treated cases. The drug resistance rates of the 12 drugs were higher in males than in females. Patients older than 60 years had significantly lower percentages of MDR/XDR-TB (7.11 and 0.65%) than in younger age groups. The proportion of re-treated cases in Shanghai (11.38%, 88/773) was lower than that in other regions. Meanwhile, the percentages of MDR/XDR-TB in Shanghai (4.79 and 0.65%) were significantly lower than in other regions. Conclusions: In this study, we found higher proportion of MDR/XDR-TB among re-treated cases than initial treated cases in China and the drug resistance rate of tuberculosis varied with age, sex, and region, indicating that standardized anti-tuberculosis treatment can reduce the incidence of drug-resistant tuberculosis and the recurrence of tuberculosis.
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Affiliation(s)
- Xiaocui Wu
- Department of Clinical Laboratory, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.,Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jinghui Yang
- Department of Clinical Laboratory, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.,Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Guangkun Tan
- Department of Clinical Laboratory, Shanghai University of Traditional Chinese Medical Attached Shuguang Hospital, Shanghai, China
| | - Haican Liu
- State Key Laboratory of Infectious Disease Prevention and Control, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yin Liu
- Department of Clinical Laboratory, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.,Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yinjuan Guo
- Department of Clinical Laboratory, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.,Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Rongliang Gao
- Department of Clinical Laboratory, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.,Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Baoshan Wan
- Department of Clinical Laboratory, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.,Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Fangyou Yu
- Department of Clinical Laboratory, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.,Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
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Prevalence and Factors Associated with Multidrug-Resistant Tuberculosis (MDR-TB) among Presumptive MDR-TB Patients in Tigray Region, Northern Ethiopia. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2019; 2019:2923549. [PMID: 31583034 PMCID: PMC6754863 DOI: 10.1155/2019/2923549] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 07/30/2019] [Indexed: 11/17/2022]
Abstract
Background Tuberculosis (TB) is one of the major public health problems. There are alarming reports of increasing multidrug-resistant tuberculosis (MTR-TB) from various parts of the globe, including Ethiopia. This study was designed to determine the prevalence and factors associated with MDR-TB among presumptive MDR-TB cases in Tigray Regional State, Ethiopia. Methods A cross-sectional study was conducted in Tigray Regional State from 2015 to 2016. Two hundred sputum samples were collected, transported, processed using 2% N-acetyl-L-cysteine-sodium hydroxide, and cultured in LJ medium. Besides, the microscopic examination was performed after ZN staining. Moreover, drug susceptibility test was done using molecular line probe assay. Descriptive statistics and binary and multivariable logistic regression were done. A statistical test was regarded as significant when the P value was <0.05. Results The prevalence of MDR-TB was found to be 18.5%. About one-fourth (26.5%) of the study participants had sputum smear positive for acid-fast bacilli (AFB). TB culture was positive in 37% of the samples, and rifampicin mono-resistant cases accounted for 3.5% of the presumptive MDR-TB cases. Three (1.5%) were new MDR-TB cases, while the rest had been treated previously for TB. Most (63.5%) of the MDR-TB cases were from 15 to 44 years of age. Age was associated with MDR-TB with a crude odds ratio of 1.06 (CI: 1.02–1.10) and adjusted odds ratio of 1.06 (CI: 1.00–1.11). Conclusions The prevalence of MDR-TB was found to be high. Preventive measures should be taken to prevent the transmission of MDR-TB in the community.
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19
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Jacobs MG, Pinto Junior VL. Brazilian cities profile, the occurence of tuberculosis an its drug-resistant form. CIENCIA & SAUDE COLETIVA 2019; 24:2379-2386. [PMID: 31340257 DOI: 10.1590/1413-81232018247.20532017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Accepted: 09/15/2017] [Indexed: 11/22/2022] Open
Abstract
Tuberculosis is closely related to living conditions. This study classifies Brazilian municipalities according to the occurrence of tuberculosis (TB) and drug-resistant TB (DR-TB) cases and describes them with regard to the population's health conditions, tuberculosis control indicators, demographic and socioeconomic profile. In 2014, 327 municipalities reported DR-TB cases. Integrated regions of development or metropolitan regions accounted for 80.1% of national DR-TB cases. Municipalities with DR-TB cases had worse TB outcome indicators, but higher culture test percentages, and more inhabitants and better socioeconomic indicators. The 3,644 municipalities with TB cases, but without DR-TB cases, had the worst socioeconomic indicators among the three groups. The 1,594 municipalities without TB cases had the lowest rates of unemployment and AIDS detection and greater coverage of primary healthcare. The different profiles found in the study can sustain improved national interventions for TB and drug-resistant TB control in Brazil.
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Affiliation(s)
- Marina Gasino Jacobs
- Departamento de Saúde Coletiva, Faculdade de Ciências da Saúde, Universidade de Brasília. Campos Univ. Darcy Ribeiro s/n, Asa Norte. 70910-900 Brasília DF Brasil.
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20
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Predictors of Multidrug-Resistant Tuberculosis (MDR-TB) in Sudan. Antibiotics (Basel) 2019; 8:antibiotics8030090. [PMID: 31323935 PMCID: PMC6783989 DOI: 10.3390/antibiotics8030090] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/03/2019] [Accepted: 07/05/2019] [Indexed: 01/17/2023] Open
Abstract
Multidrug-resistant tuberculosis (MDR-TB) is a global public health threat and burden on the health system. This is especially the case in high tuberculosis (TB) prevalence countries, such as Sudan. Consequently, this study aimed to ascertain the predictors of MDR-TB in Sudan to provide future guidance. An unmatched case-control study to assess the predictors of MDR-TB infections among the Sudanese population was conducted from August 2017 to January 2018 at Abu-Anga referral hospital. Patients’ data was gathered from patients’ cards and via interviews. A structured pre-validated questionnaire was used to gather pertinent information, which included sociodemographic characteristics and other relevant clinical data. Univariate and multivariate logistic regression analysis was employed to determine the predictors of MDR-TB infection. 76 of the 183 patients interviewed (41.5%) had MDR-TB cases. The independent predictors for MDR-TB were living in rural areas [adjusted odds ratio (aOR) = 3.1 (95% confidence interval (CI): 1.2–8.2)], treatment failure [aOR = 56.9 (10.2–319.2)], and smoking [(aOR = 4 (1.2–13.2)], whereas other sociodemographic factors did not predict MDR-TB. In conclusion, the study showed that a history of smoking, living in rural areas, and a previous treatment failure were the predictors of MDR-TB in Sudan. The latter factors are most likely due to issues that are related to access and adherence to treatment and lifestyle. The existence of any of these factors among newly diagnosed TB patients should alert clinicians for the screening of MDR-TB. The implementation of directly observed treatment (DOT) and health education are crucial in stopping the spread of MDR-TB in Sudan.
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Sharma P, Lalwani J, Pandey P, Thakur A. Factors Associated with the Development of Secondary Multidrug-resistant Tuberculosis. Int J Prev Med 2019; 10:67. [PMID: 31198502 PMCID: PMC6547804 DOI: 10.4103/ijpvm.ijpvm_298_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 11/22/2017] [Indexed: 11/04/2022] Open
Abstract
Background Spread of multidrug-resistant tuberculosis (TB) is a threat to India's TB control program. We conducted this study with the objective to determine the risk factors for the development of secondary multidrug-resistant TB. Methods We conducted an unmatched case-control study involving 247 multidrug-resistant TB patients as "cases" and 494 individuals who were declared as "cured" after category I DOTS treatment as "controls." Data were collected through face-to-face interviews and review of treatment records. Multivariable logistic regressions were used to analyze the collected data. Results The mean duration for which cases took first-line anti-TB drug was 19.7 months. The mean duration between initial diagnosis of TB and diagnosis of multi-drug resistant TB (MDR-TB) was 28.3 months. In our study, 26.7%, 50.2%, and 23.1% of MDR-TB cases had one, two, or more previous episodes of TB before being diagnosed as MDR-TB. In multivariable analysis, low or no formal education (album-oriented rock [AOR] =1.63 [confidence interval (CI) = 1.03-3.11]), labor occupation (AOR = 2.15 [CI = 1.18-3.90]), smoking (AOR = 2.56 [CI = 1.19-3.26]), having HIV (AOR = 9.45 [CI = 6.80-15.9]), migration for job (AOR = 3.70 [CI = 1.96-5.67]), stopping TB treatment due to comorbid conditions (AOR = 8.86 [CI = 5.45-11.2]), and having type 2 diabetes (AOR = 3.4 [CI = 1.96-5.16]) were associated with MDR-TB. Conclusions Government of India should devise strategy to prevent interruption of treatment to stop the emergence and spread of MDR-TB. We need to better integrate TB control activities with diabetes and tobacco control programs for better health outcome among patients.
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Affiliation(s)
- Parag Sharma
- Department of TB and Chest, Gandhi Medical College, Bhopal, Madhya Pradesh, India
| | - Jaya Lalwani
- Department of Microbiology, Gandhi Medical College, Bhopal, Madhya Pradesh, India
| | - Pavan Pandey
- Jhpiego (formerly Johns Hopkins Program for International Education in Gynecology and Obstetrics), India
| | - Avinash Thakur
- Department of Forensic Medicine and Toxicology, Gandhi Medical College, Bhopal, Madhya Pradesh, India
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22
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Elduma AH, Mansournia MA, Foroushani AR, Ali HMH, Elegail AMA, Elsony A, Holakouie-Naieni K. Assessment of the risk factors associated with multidrug-resistant tuberculosis in Sudan: a case-control study. Epidemiol Health 2019; 41:e2019014. [PMID: 31010280 PMCID: PMC6545493 DOI: 10.4178/epih.e2019014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 04/20/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES The emergence of multidrug-resistant tuberculosis (MDR-TB) is a major challenge for the global control of tuberculosis (TB). The aim of this study was to determine the risk factors associated with MDR-TB in Sudan. METHODS This case-control study was conducted from May 2017 to February 2019. Patients newly diagnosed with MDR-TB were selected as cases, and controls were selected from TB patients who responded to first-line anti-TB drugs. A questionnaire was designed and used to collect data from study participants. Logistic regression was used to evaluate associations between risk factors and MDR-TB infection. The best multivariate model was selected based on the likelihood ratio test. RESULTS A total of 430 cases and 860 controls were selected for this study. A history of previous TB treatment (adjusted odds ratio [aOR], 54.85; 95% confidence interval [CI], 30.48 to 98.69) was strongly associated with MDR-TB infection. We identified interruption of TB treatment (aOR, 7.62; 95% CI, 3.16 to 18.34), contact with MDR-TB patients (aOR, 5.40; 95% CI, 2.69 to 10.74), lower body weight (aOR, 0.89; 95% CI, 0.87 to 0.91), and water pipe smoking (aOR, 3.23; 95% CI, 1.73 to 6.04) as factors associated with MDR-TB infection. CONCLUSIONS Previous TB treatment and interruption of TB treatment were found to be the main predictors of MDR-TB. Additionally, this study found that contact with MDR-TB patients and water pipe smoking were associated with MDR-TB infection in Sudan. More efforts are required to decrease the rate of treatment interruption, to strengthen patients’ adherence to treatment, and to reduce contact with MDR-TB patients.
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Affiliation(s)
- Adel Hussein Elduma
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences-International Campus, Tehran, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Rahimi Foroushani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamdan Mustafa Hamdan Ali
- Multidrug-Resistant Tuberculosis Unit, Communicable and Non-Communicable Diseases Control Directorate, Ministry of Health, Khartoum, Sudan
| | - Asrar M A/Salam Elegail
- National Tuberculosis Reference Laboratory, National Public Health Laboratory, Ministry of Health, Khartoum, Sudan
| | - Asma Elsony
- The Epidemiological Laboratory (Epi-Lab), Khartoum, Sudan
| | - Kourosh Holakouie-Naieni
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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23
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Alene KA, Viney K, McBryde ES, Gray DJ, Melku M, Clements ACA. Risk factors for multidrug-resistant tuberculosis in northwest Ethiopia: A case-control study. Transbound Emerg Dis 2019; 66:1611-1618. [PMID: 30924283 DOI: 10.1111/tbed.13188] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 03/19/2019] [Accepted: 03/22/2019] [Indexed: 11/29/2022]
Abstract
Ethiopia is one of 30-high burden multidrug-resistant tuberculosis (MDR-TB) countries globally. The aim of this study was to describe the characteristics of patients with MDR-TB and to investigate risk factors for MDR-TB relative to having drug-susceptible tuberculosis (TB), in northwest Ethiopia. A hospital-based, unmatched case-control study was conducted. Cases were all MDR-TB patients (i.e., resistant to at least rifampicin and isoniazid) who were confirmed by culture and drug-susceptibility testing whilst enrolled on treatment at Gondar University Hospital. Controls were all drug-susceptible tuberculosis (DS-TB) patients who were confirmed by Gene Xpert MTB/RIF at Gondar University Hospital. Univariable and multivariable logistic regression models were used for comparisons, and odds ratios with 95% confidence intervals (CI) were computed to measure the strength of association between the dependent and independent variables. A total of 452 patients (242 MDR-TB and 210 DS-TB) were included in this study. The mean age of the study participants was 33 years (SD ± 14 years). Approximately one-fifth (78, 17%) of all study participants were human immunodeficiency virus (HIV) positive; 21% (51) of cases and 13% (27) of controls. Risk factors associated with MDR-TB were a history of previous TB treatment (Adjusted Odds Ratio (AOR): 83.8; 95% CI: 40.7, 172.5), low educational status (AOR: 5.32; 95% CI: 1.43, 19.81); and ages less than 20 years (AOR: 9.01; 95% CI: 2.30, 35.25) and 21-30 years (AOR: 2.61; 95% CI: 1.02, 6.64). HIV infection was also significantly associated with MDR-TB among new TB patients (AOR: 5.55; 95% CI: 1.17, 26.20). This study shows that clinical and demographic features can be used to indicate higher risks of drug resistance in this setting.
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Affiliation(s)
- Kefyalew Addis Alene
- School of Public Health, Curtin University, Bentley, WA, Australia.,Research School of Population Health, College of Health and Medicine, The Australian National University, Canberra, ACT, Australia.,Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.,Telethon Kids Institute, Perth, WA, Australia
| | - Kerri Viney
- Research School of Population Health, College of Health and Medicine, The Australian National University, Canberra, ACT, Australia.,Department of Public Health Sciences, Centre for Global Health, Karolinska Institutet, Stockholm, Sweden
| | - Emma S McBryde
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia
| | - Darren J Gray
- Research School of Population Health, College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
| | - Mulugeta Melku
- School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Archie C A Clements
- School of Public Health, Curtin University, Bentley, WA, Australia.,Telethon Kids Institute, Perth, WA, Australia
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24
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Tegegne BS, Mengesha MM, Teferra AA, Awoke MA, Habtewold TD. Association between diabetes mellitus and multi-drug-resistant tuberculosis: evidence from a systematic review and meta-analysis. Syst Rev 2018; 7:161. [PMID: 30322409 PMCID: PMC6190557 DOI: 10.1186/s13643-018-0828-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/01/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Diabetes mellitus (DM) poses a significant risk for the development of active tuberculosis (TB) and complicates its treatment. However, there is inconclusive evidence on whether the TB-DM co-morbidity is associated with a higher risk of developing multi-drug-resistant tuberculosis (MDR-TB). The aim of this meta-analysis was to summarize available evidence on the association of DM and MDR-TB and to estimate a pooled effect measure. METHODS PubMed, Excerpta Medica Database (EMBASE), Web of Science, World Health Organization (WHO), and Global Health Library database were searched for all studies published in English until July 2018 and that reported the association of DM and MDR-TB among TB patients. To assess study quality, we used the Newcastle-Ottawa Scale for cohort and case-control studies and the Agency for Healthcare Research and Quality tool for cross-sectional studies. We checked the between-study heterogeneity using the Cochrane Q chi-squared statistic and I2 and examined a potential publication bias by visual inspection of the funnel plot and Egger's regression test statistic. The random-effect model was fitted to estimate the summary effects, odds ratios (ORs), and 95% confidence interval (CIs) across studies. RESULTS This meta-analysis of 24 observational studies from 15 different countries revealed that DM has a significant association with MDR-TB (OR = 1.97, 95% CI = 1.58-2.45, I2 = 38.2%, P value for heterogeneity = 0.031). The significant positive association remained irrespective of country income level, type of DM, how TB or DM was diagnosed, and design of primary studies. A stronger association was noted in a pooled estimate of studies which adjusted for at least one confounding factor, OR = 2.43, 95% CI 1.90 to 3.12. There was no significant publication bias detected. CONCLUSIONS The results suggest that DM can significantly increase the odds of developing MDR-TB. Consequently, a more robust TB treatment and follow-up might be necessary for patients with DM. Efforts to control DM can have a substantial beneficial effect on TB outcomes, particularly in the case of MDR-TB. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016045692 .
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Affiliation(s)
- Balewgizie Sileshi Tegegne
- Department of Epidemiology and Biostatistics, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.,Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Melkamu Merid Mengesha
- Department of Epidemiology and Biostatistics, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
| | - Andreas A Teferra
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Mamaru Ayenew Awoke
- Amref Health Africa in Ethiopia, Monitoring, Evaluation and Research Unit, Addis Ababa, Ethiopia
| | - Tesfa Dejenie Habtewold
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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25
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Stosic M, Vukovic D, Babic D, Antonijevic G, Foley KL, Vujcic I, Grujicic SS. Risk factors for multidrug-resistant tuberculosis among tuberculosis patients in Serbia: a case-control study. BMC Public Health 2018; 18:1114. [PMID: 30208864 PMCID: PMC6134722 DOI: 10.1186/s12889-018-6021-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 09/06/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Multidrug resistant (MDR) tuberculosis (TB) represents TB which is simultaneous resistant to at least rifampicin (R) and isoniazid (H). Identifying inadequate therapy as the main cause of this form of the disease and explaining the factors leading to its occurrence, numerous social determinants that affect the risk of developing resistance are highlighted. The objectives of the study was to identify independent factors of MDR-TB among tuberculosis patients. METHODS Case-control study was conducted from 1st September 2009 to 1st June 2014 in 31 healthcare institutions in Serbia where MDR-TB and TB patients were treated. TB patients infected with MDR- M. tuberculosis and non MDR- M. tuberculosis strain were considered as cases and controls, respectively. Cases and controls were matched by the date of hospitalization. The data was collected using structured questionnaire with face to face interview. Bivariate and multivariable logistic regression analysis (MLRA) were used to identify determinants associated with MDR-TB. RESULTS A total of 124 respondents, 31 cases and 93 controls were participated in the study. MLRA identified six significant independent risk factors for the occurrence of MDR-TB as follows: monthly income of the family (Odds ratio (OR) = 3.71; 95% Confidence Interval (CI) = 1.22-11.28), defaulting from treatment (OR = 3.33; 95% CI = 1.14-9.09), stigma associated with TB (OR = 2.97; 95% CI = 1.18-7.45), subjective feeling of sadness (OR = 4.05; 95% CI = 1.69-9.70), use of sedatives (OR = 2.79; 95% CI = 1.02-7.65) and chronic obstructive pulmonary disease (OR = 4.51; 95% CI = 1.07-18.96). CONCLUSION In order to reduce burden of drug resistance, strategies of controlling MDR-TB in Serbia should emphasize multi-sectorial actions, addressing health care and social needs of TB patients.
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Affiliation(s)
- Maja Stosic
- Department of HIV/AIDS, STIs, Viral Hepatitis and TB, Public Health Institute of Serbia, "Dr Milan Jovanovic Batut", Dr Subotica 5, Belgrade, 11000, Serbia
| | - Dejana Vukovic
- Institute of Social Medicine, Faculty of Medicine, Belgrade University, Dr Subotica 9, Belgrade, 11000, Serbia
| | - Dragan Babic
- Institute of Medical Statistics and Informatics, Faculty of Medicine, Belgrade University, Dr Subotica 9, Belgrade, 11000, Serbia
| | - Gordana Antonijevic
- Special Hospital for Lung Diseases, "Ozren"Ozrenska bb, Sokobanja, 18230, Serbia
| | - Kristie L Foley
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Isidora Vujcic
- Institute of Epidemiology, Faculty of Medicine, Belgrade University, Visegradska 26, Belgrade, 11000, Serbia
| | - Sandra Sipetic Grujicic
- Institute of Epidemiology, Faculty of Medicine, Belgrade University, Visegradska 26, Belgrade, 11000, Serbia.
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26
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Wang MG, Huang WW, Wang Y, Zhang YX, Zhang MM, Wu SQ, Sandford AJ, He JQ. Association between tobacco smoking and drug-resistant tuberculosis. Infect Drug Resist 2018; 11:873-887. [PMID: 29928135 PMCID: PMC6003534 DOI: 10.2147/idr.s164596] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background Tobacco smoking is a risk factor for tuberculosis but little is known about the relationship between tobacco smoking and drug-resistant tuberculosis (DR-TB). We undertook a systematic review and meta-analysis to quantitatively assess the association between DR-TB and tobacco smoking. Methods We searched for relevant studies in the Ovid MEDLINE, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, WANFANG, and WEIPU data-bases from inception to September 1, 2017. Results were expressed as odds ratios (ORs) with accompanying 95% CIs, and subgroup analyses were performed by study design, smoking type, DR-TB type, and multivariate analysis. Results Thirty-three studies related to tobacco smoking and DR-TB were included. We found substantial evidence that tobacco smoking is associated with an increased risk of DR-TB (OR 1.57, 95% CI 1.33–1.86). Associations were also found in subgroup analyses: for multidrug-resistant tuberculosis (OR 1.49, 95% CI 1.19–1.86) and for any DR-TB (OR 1.70, 95% CI 1.3–2.23); the pooled OR was 1.45 (95% CI 1.11–1.90) for current smoking, 2.25 (95% CI 1.46–3.47) for past smoking, and 1.56 (95% CI 1.22–1.98) for smoking history; and similar ORs were also observed in study design and multivariate analysis subgroup analysis. Conclusion This study demonstrated that tobacco smoking is an independent risk factor for DR-TB.
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Affiliation(s)
- Ming-Gui Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Wei-Wei Huang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Yu Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Yun-Xia Zhang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Miao-Miao Zhang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Shou-Quan Wu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Andrew J Sandford
- Centre for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, BC, Canada
| | - Jian-Qing He
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
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27
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Khan MS, Hutchison C, Coker RJ, Yoong J, Hane KM, Innes AL, Khaing TM, Aung S. Preventing emergence of drug resistant tuberculosis in Myanmar's transitioning health system. Health Policy Plan 2018; 32:i43-i50. [PMID: 29028228 DOI: 10.1093/heapol/czx093] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2017] [Indexed: 12/26/2022] Open
Abstract
Multidrug-resistant tuberculosis (MDR-TB) is a particular threat to the populations of resource-limited countries. Although inadequate treatment of TB has been identified as a major underlying cause of drug resistance, essential information to inform changes in health service delivery and policy is missing. We investigate factors that may be driving the emergence of MDR-TB in Myanmar, a country where investment and health system reforms are ongoing to address the unexplained, high occurrence of MDR-TB. We conducted a multi-centre, retrospective case-control study in 10 townships across Yangon. Cases were 202 GeneXpert-confirmed MDR-TB patients with a history of prior first-line treatment for TB. Controls were 404 previously untreated smear-microscopy confirmed TB patients who had no evidence of resistance to anti-TB drugs. Information on patient and health service factors was collected through face-to-face patient interviews and hospital record reviews. Multivariable logistic regression analysis indicated that the following TB patient groups are at higher risk of developing MDR-TB after initial TB treatment: those who have diabetes (aOR 2.10; 95% CI 1.17-3.76), those who missed taking drugs during the initial treatment more than once weekly (aOR 2.35; 95% CI 1.18-4.65) and those with a higher socioeconomic (aOR 1.99; 95% CI 1.09-3.63) or educational status (aOR 1.78; 95% CI1.01-3.13). Coinciding with a surge in funding to improve health in Myanmar, this study identifies practices of patients and healthcare organizations that can be addressed, and high-risk TB patient groups that can be prioritized for treatment support. Specifically, the study shows that TB patients who experience frequent, short interruptions in treatment and those with diabetes may require enhanced treatment support and monitoring by health services in order to prevent further generation of drug resistance.
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Affiliation(s)
- Mishal S Khan
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore 117549, Singapore.,Communicable Diseases Policy Research Group, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK
| | - Coll Hutchison
- Communicable Diseases Policy Research Group, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK
| | - Richard J Coker
- Communicable Diseases Policy Research Group, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK.,Faculty of Public Health, Mahidol University, 420/1 Ratchawithi RD, Ratchathewi District, Bangkok 10400, Thailand
| | - Joanne Yoong
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore 117549, Singapore.,Centre for Economic and Social Research, University of Southern California, 635 Downey Way, VPD, Los Angeles, CA 90089, USA
| | - Khaung M Hane
- Family Health International Myanmar Office, 133 Mawyawaddi Street, 8?Mile Mayangone Township, Yangon, Myanmar
| | - Anh L Innes
- Family Health International Asia Pacific Regional Office, 19th Floor, Tower 3 Sindhorn Building 130-132 Wireless Road Kwaeng Lumpini, Khet Phatumwan, Bangkok 10330, Thailand
| | - Tin M Khaing
- National Tuberculosis Programme, Yangon, Myanmar
| | - Sithu Aung
- National Tuberculosis Programme, Yangon, Myanmar
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28
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Tan D, Wang B, Li X, Cai X, Zhang D, Li M, Tang C, Yan Y, Yu S, Chu Q, Xu Y. Identification of Risk Factors of Multidrug-Resistant Tuberculosis by using Classification Tree Method. Am J Trop Med Hyg 2017; 97:1720-1725. [PMID: 29016283 DOI: 10.4269/ajtmh.17-0029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Multidrug-resistant tuberculosis (MDR-TB) has become a major public health problem. We tried to apply the classification tree model in building and evaluating a risk prediction model for MDR-TB. In this case-control study, 74 newly diagnosed MDR-TB patients served as the case group, and 95 patients without TB from the same medical institution served as the control group. The classification tree model was built using Chi-square Automatic Interaction Detectormethod and evaluated by income diagram, index map, risk statistic, and the area under receiver operating characteristic (ROC) curve. Four explanatory variables (history of exposure to TB patients, family with financial difficulties, history of other chronic respiratory diseases, and history of smoking) were included in the prediction model. The risk statistic of misclassification probability of the model was 0.160, and the area under ROC curve was 0.838 (P < 0.01). These suggest that the classification tree model works well for predicting MDR-TB. Classification tree model can not only predict the risk of MDR-TB effectively but also can reveal the interactions among variables.
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Affiliation(s)
- Dixin Tan
- The Ministry of Education (MOE) Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Bin Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xuhui Li
- The Ministry of Education (MOE) Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaonan Cai
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Dandan Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Mengyu Li
- The Ministry of Education (MOE) Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Cong Tang
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yaqiong Yan
- Wuhan Centers for Disease Control and Prevention, Wuhan, Hubei, China
| | - Songlin Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qian Chu
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yihua Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,The Ministry of Education (MOE) Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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RSSDI clinical practice recommendations for diagnosis, prevention, and control of the diabetes mellitus-tuberculosis double burden. Int J Diabetes Dev Ctries 2017. [DOI: 10.1007/s13410-017-0577-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Peng Y, Chen SH, Zhang L, Chen B, Zhang MW, He TN, Wang F, Chai CL, Zhou L, Zhang Y, Wang XM, Jia Z. Multidrug-resistant Tuberculosis Burden among the New Tuberculosis Patients in Zhejiang Province: An Observational Study, 2009-2013. Chin Med J (Engl) 2017; 130:2021-2026. [PMID: 28836544 PMCID: PMC5586168 DOI: 10.4103/0366-6999.213413] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Screening on multidrug-resistant tuberculosis (MDR-TB) has been limited to the serious TB subpopulations excluding the new TB patients. This study aimed to examine MDR-TB burden among the new TB patients. METHODS We conducted a study in Zhejiang Province during 2009-2013 to screen for MDR-TB patients among the low MDR-TB risk patients and five subpopulations of high MDR-TB risk patients. The number, prevalence, and trend of MDR-TB were compared while the logistic regression model was used to examine risk factors related to MDR-TB. RESULTS A total of 200 and 791 MDR-TB cases were, respectively, identified from the 9830 new TB cases and 2372 high-risk suspects who took MDR-TB screening from 2009 to 2013. The MDR-TB rates went down in both of the new TB patients and five MDR-TB high-risk groups over the study time, but the percentage of MDR-TB patients identified from the new TB patients in all diagnosed MDR-TB cases kept stable from 28.3% in 2011 to 27.0% in 2012 to 26.0% in 2013. CONCLUSIONS The study indicated that MDR-TB burden among new TB patients was high, thus screening for MDR-TB among the new TB patients should be recommended in China as well as in the similar situation worldwide.
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Affiliation(s)
- Ying Peng
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang 310051, China
| | - Song-Hua Chen
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang 310051, China
| | - Le Zhang
- National Institute of Drug Dependence, Peking University, Beijing 100191, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Bin Chen
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang 310051, China
| | - Ming-Wu Zhang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang 310051, China
| | - Tie-Niu He
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang 310051, China
| | - Fei Wang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang 310051, China
| | - Cheng-Liang Chai
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang 310051, China
| | - Lin Zhou
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang 310051, China
| | - Yu Zhang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang 310051, China
| | - Xiao-Meng Wang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang 310051, China
| | - Zhongwei Jia
- National Institute of Drug Dependence, Peking University, Beijing 100191, China
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Diabetes mellitus and the risk of multidrug resistant tuberculosis: a meta-analysis. Sci Rep 2017; 7:1090. [PMID: 28439071 PMCID: PMC5430797 DOI: 10.1038/s41598-017-01213-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 03/20/2017] [Indexed: 02/05/2023] Open
Abstract
The high prevalence of diabetes mellitus (DM) among multidrug resistant tuberculosis (MDR-TB) patients is a serious cause for concern. We conducted a meta-analysis to determine whether DM is an independent risk factor for MDR-TB. Electronic literature searches of the PubMed, Web of Science and EMBASE databases up to July 12, 2016 were conducted. The pooled adjusted odds ratio (OR) and 95% confidence intervals (CIs) were calculated using the random effects model with STATA 12.0 software. In total 13 studies, including 9289 individuals with TB, were included in this meta-analysis. Significant association between DM and MDR-TB (OR = 1.71; 95% CI = 1.32, 2.22) was identified. Subgroup analyses showed that: 1) Pooled OR was 1.25 (95% CI: 0.82-1.91) for cross-sectional studies, and was 2.14 (95% CI: 1.51-3.02) for longitudinal studies; 2) The pooled OR was 1.69 (95% CI:1.09-2.62) for primary MDR-TB, 1.94 (95% CI:1.42-2.65) for any MDR-TB, and 0.85 for secondary MDR-TB (95% CI: 0.29-2.54); 3) DM was significantly associated with MDR-TB in both Caucasian (OR = 2.26, 95% CI: 1.66-3.07) and Asian (OR = 1.40, 95% CI: 1.01-1.95) subgroups. No evidence of publication bias was identified. In conclusion, the pooling analysis indicated that DM was an independent risk factor for MDR-TB, especially for primary MDR-TB.
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Naidoo P, Dunbar R, Caldwell J, Lombard C, Beyers N. Has universal screening with Xpert® MTB/RIF increased the proportion of multidrug-resistant tuberculosis cases diagnosed in a routine operational setting? PLoS One 2017; 12:e0172143. [PMID: 28199375 PMCID: PMC5310774 DOI: 10.1371/journal.pone.0172143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 01/31/2017] [Indexed: 01/30/2023] Open
Abstract
SETTING Primary health services in Cape Town, South Africa where the introduction of Xpert® MTB/RIF (Xpert) enabled simultaneous screening for tuberculosis (TB) and drug susceptibility in all presumptive cases. STUDY AIM To compare the proportion of TB cases with drug susceptibility tests undertaken and multidrug-resistant tuberculosis (MDR-TB) diagnosed pre-treatment and during the course of 1st line treatment in the previous smear/culture and the newly introduced Xpert-based algorithms. METHODS TB cases identified in a previous stepped-wedge study of TB yield in five sub-districts over seven one-month time-points prior to, during and after the introduction of the Xpert-based algorithm were analysed. We used a combination of patient identifiers to identify all drug susceptibility tests undertaken from electronic laboratory records. Differences in the proportions of DST undertaken and MDR-TB cases diagnosed between algorithms were estimated using a binomial regression model. RESULTS Pre-treatment, the probability of having a DST undertaken (RR = 1.82)(p<0.001) and being diagnosed with MDR-TB (RR = 1.42)(p<0.001) was higher in the Xpert-based algorithm than in the smear/culture-based algorithm. For cases evaluated during the course of 1st-line TB treatment, there was no significant difference in the proportion with DST undertaken (RR = 1.02)(p = 0.848) or MDR-TB diagnosed (RR = 1.12)(p = 0.678) between algorithms. CONCLUSION Universal screening for drug susceptibility in all presumptive TB cases in the Xpert-based algorithm resulted in a higher overall proportion of MDR-TB cases being diagnosed and is an important strategy in reducing transmission. The previous strategy of only screening new TB cases when 1st line treatment failed did not compensate for cases missed pre-treatment.
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Affiliation(s)
- Pren Naidoo
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Rory Dunbar
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | | | - Carl Lombard
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
| | - Nulda Beyers
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
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Tegegne BS, Habtewold TD, Mengesha MM, Burgerhof JGM. Association between diabetes mellitus and multi-drug-resistant tuberculosis: a protocol for a systematic review and meta-analysis. Syst Rev 2017; 6:6. [PMID: 28088237 PMCID: PMC5237566 DOI: 10.1186/s13643-017-0407-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 01/05/2017] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Multi-drug-resistant tuberculosis (MDR-TB) has emerged as a challenge to global tuberculosis (TB) control and remains a major public health concern in many countries. Diabetes mellitus (DM) is an increasingly recognized comorbidity that can both accelerate TB disease and complicate its treatment. The aim of this study is to summarize available evidence on the association of DM and MDR-TB among TB patients and to provide a pooled estimate of risks. METHODS All studies published in English before October 2016 will be searched using comprehensive search strings through PubMed, EMBASE, Web of Science, and WHO Global Health Library databases which have reported the association of DM and MDR-TB in adults with TB (age > =15). Two authors will independently collect detailed information using structured data abstraction form. The quality of studies will be checked using Newcastle-Ottawa Scale for cohort and case-control studies and the Agency for Healthcare Research and Quality tool for cross-sectional studies. Heterogeneity between included studies will be assessed using the I2 statistic. We will check potential publication bias by visual inspection of the funnel plot and Egger's regression test statistic. We will use the random effects model to compute a pooled estimate. DISCUSSION Increases in the burden of non-communicable diseases and aging populations are changing the importance of different risk factors for TB, and the profile of comorbidities and clinical challenges for people with TB. Although classic risk factors and comorbidities such as overcrowding, under-nutrition, silicosis, and HIV infection are crucial to address, chronic conditions like diabetes are important factors that impair host defenses against TB. Thus, undertaking integrated multifaceted approach is remarkably necessary for reducing the burden of DM and successful TB treatment outcome. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016045692 .
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Affiliation(s)
- Balewgizie Sileshi Tegegne
- Department of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia. .,Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Tesfa Dejenie Habtewold
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Melkamu Merid Mengesha
- Department of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Johannes G M Burgerhof
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Double Trouble: Prevalence and Factors Associated with Tuberculosis and Diabetes Comorbidity in Bangladesh. PLoS One 2016; 11:e0165396. [PMID: 27798659 PMCID: PMC5087880 DOI: 10.1371/journal.pone.0165396] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 10/11/2016] [Indexed: 01/09/2023] Open
Abstract
Background Diabetes among tuberculosis patients increases the risk of tuberculosis treatment failure, death, and development of multidrug-resistant tuberculosis. Yet, there is no data is available in Bangladesh on the prevalence of diabetes among tuberculosis patients. The objective of the current study was to estimate prevalence and identify factors associated with tuberculosis-diabetes co-morbidity among TB patients enrolled in the Directly Observed Treatment, Short course program. Methods A community based cross-sectional quantitative study was conducted among 1910 tuberculosis patients living in six urban and eleven rural areas among whom Oral Glucose Tolerance Test (those who fasted) and Random Blood Sugar test (those who did not fast) were performed. Besides glucose levels, data on socio-demographic information, family history of diabetes and anthropometric measurements (height and weight) were also collected. Result Among the 1910 TB patients who participated in screening for diabetes, 245 (12.8%) were found to have diabetes and 296 (15.5%) to have pre-diabetes. Out of those who had diabetes, 34.7% were newly diagnosed through the current study and 65.3% already knew their status. Among those who were found to have prediabetes, 27 (9.1%) had impaired Fasting Blood Glucose (FBG), 230 (77.7%) had Impaired Glucose Tolerance (IGT), and 39 (13.2%) had both Impaired FBG and IGT. Older age, higher BMI, higher education (secondary level and above), being married, participation in less active work, and family history of diabetes are associated with higher prevalence of diabetes. Conclusion We observed a higher prevalence of diabetes and pre-diabetes in TB patients than reported previously in Bangladesh among the general population which may challenge TB and diabetes control in Bangladesh. Diabetes diagnosis, treatment and care should be integrated in the National TB Program.
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Salindri AD, Kipiani M, Kempker RR, Gandhi NR, Darchia L, Tukvadze N, Blumberg HM, Magee MJ. Diabetes Reduces the Rate of Sputum Culture Conversion in Patients With Newly Diagnosed Multidrug-Resistant Tuberculosis. Open Forum Infect Dis 2016; 3:ofw126. [PMID: 27419188 PMCID: PMC4942763 DOI: 10.1093/ofid/ofw126] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 06/14/2016] [Indexed: 11/13/2022] Open
Abstract
Background. Diabetes is a risk factor for active tuberculosis (TB), but little is known about the relationship between diabetes and multidrug-resistant (MDR) TB. We aimed to assess risk factors for primary MDR TB, including diabetes, and determine whether diabetes reduced the rate of sputum culture conversion among patients with MDR TB. Methods. From 2011 to 2014, we conducted a cohort study at the National Center for Tuberculosis and Lung Diseases in Tbilisi, Georgia. Adult (≥35 years) patients with primary TB were eligible. Multidrug-resistant TB was defined as resistance to at least rifampicin and isoniazid. Patients with capillary glycosylated hemoglobin (HbA1c) ≥ 6.5% or previous diagnosis were defined to have diabetes. Polytomous regression was used to estimate the association of patient characteristics with drug resistance. Cox regression was used to compare rates of sputum culture conversion in patients with and without diabetes. Results. Among 318 patients with TB, 268 had drug-susceptibility test (DST) results. Among patients with DST results, 19.4% (52 of 268) had primary MDR TB and 13.4% (36 of 268) had diabetes. In multivariable analyses, diabetes (adjusted odds ratio [aOR], 2.51; 95% confidence interval [CI], 1.00-6.31) and lower socioeconomic status (aOR, 3.51; 95% CI, 1.56-8.20) were associated with primary MDR TB. Among patients with primary MDR TB, 44 (84.6%) converted sputum cultures to negative. The rate of sputum culture conversion was lower among patients with diabetes (adjusted hazard ratio [aHR], 0.34; 95% CI, .13-.87) and among smokers (aHR, 0.16; 95% CI, .04-.61). Conclusions. We found diabetes was associated with an increased risk of primary MDR TB; both diabetes and smoking were associated with a longer time to sputum culture conversion.
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Affiliation(s)
- Argita D Salindri
- Division of Epidemiology and Biostatistics , School of Public Health, Georgia State University
| | - Maia Kipiani
- National Center for Tuberculosis and Lung Disease, Tbilisi, Country of Georgia
| | - Russell R Kempker
- Division of Infectious Diseases, Department of Medicine , Emory University School of Medicine
| | - Neel R Gandhi
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine; Departments of Epidemiology and Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Lasha Darchia
- National Center for Tuberculosis and Lung Disease, Tbilisi, Country of Georgia
| | - Nestani Tukvadze
- National Center for Tuberculosis and Lung Disease, Tbilisi, Country of Georgia
| | - Henry M Blumberg
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine; Departments of Epidemiology and Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Matthew J Magee
- Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University; Departments of Epidemiology and Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
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He XC, Zhang XX, Zhao JN, Liu Y, Yu CB, Yang GR, Li HC. Epidemiological Trends of Drug-Resistant Tuberculosis in China From 2007 to 2014: A Retrospective Study. Medicine (Baltimore) 2016; 95:e3336. [PMID: 27082586 PMCID: PMC4839830 DOI: 10.1097/md.0000000000003336] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 03/11/2016] [Accepted: 03/11/2016] [Indexed: 11/26/2022] Open
Abstract
The emergence and spread of drug-resistant tuberculosis (DR-TB) has become the major concern in global TB control nowadays due to its limited therapy options and high mortality. A comprehensive evaluation for the epidemiological trends of DR-TB in mainland China, of which TB incidences remain high, is essential but lacking. This study aimed to describe the trends of DR-TB overtime, especially multidrug-resistant TB (MDR-TB); and to identify unique characteristics of MDR-TB cases compared with drug-susceptible TB cases in Mainland China. We retrospectively analyzed surveillance data collected from 36 TB prevention and control institutions in Shandong Province, China over an 8-year period. Unique characteristics of MDR-TB were identified; Chi-square test for trends and linear regression were used to assess the changes in proportions of different resistance patterns overtime. The overall MDR rate was 6.2% in our sample population. There were no statistically significant changes in the percentage of drug-susceptible, isoniazid (INH) resistance, ethambutol (EMB) resistance, streptomycin (SM) resistance, and MDR TB during our study period except that the overall rifampin (RFP) resistance and rifampin monoresistance (RMR) increased at a yearly rate of 0.2% and 0.1%, respectively. Among those with known treatment histories, a higher MDR rate of 8.7% was observed, in which 53.9% were primary MDR-TB patients, and this rate was increasing at a yearly rate of 4.1% over our study period. MDR-TB patients were more likely to be female (odds ratio [OR], 1.23; 95% confidence interval [CI], 1.05-1.34), aged 25 to 44 years (OR, 1.67; 95%CI, 1.45-1.93), retreated (OR, 11.95; 95%CI, 9.68-14.76), having prior TB contact (OR, 1.89; 95%CI, 1.19-2.78) and having cavity (OR, 1.57; 95%CI 1.36-1.81), or bilateral disease (OR, 1.45; 95%CI 1.19-1.76) on chest radiology. Persistent high levels of MDR-TB, increasing rates of primary MDR-TB and RMR characterize DR-TB cases in mainland China; community-acquired drug resistance may be one of the most modifiable factors in future TB control strategies.
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Affiliation(s)
- Xiao-Chun He
- From the Department of Respiratory Medicine (X-CH, YL, H-CL), Shandong Provincial Hospital Affiliated to Shandong University, Jinan; College of Pharmacy (X-CH), Shandong University, Jinan; Department of Respiratory Medicine (X-XZ), Shandong Provincial Chest Hospital, Jinan; Department of Respiratory Medicine (J-NZ), The First Hospital of Jiaxing, Jiaxing; Katharine Hsu International Research Center of Human Infectious Diseases (C-BY), Shandong Provincial Chest Hospital, Jinan; and Department of Respiratory and Critical Care Medicine (G-RY), The Second People's Hospital of Weifang, Weifang, China
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Gao J, Ma Y, Du J, Zhu G, Tan S, Fu Y, Ma L, Zhang L, Liu F, Hu D, Zhang Y, Li X, Li L, Li Q. Later emergence of acquired drug resistance and its effect on treatment outcome in patients treated with Standard Short-Course Chemotherapy for tuberculosis. BMC Pulm Med 2016; 16:26. [PMID: 26846562 PMCID: PMC4743330 DOI: 10.1186/s12890-016-0187-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 01/22/2016] [Indexed: 11/18/2022] Open
Abstract
Backgrounds The failure of current Standard Short-Course Chemotherapy (SCC) in new and previously treated cases with tuberculosis (TB) was mainly due to drug resistance development. But little is known on the characteristics of acquired drug resistant TB during SCC and its correlation with SCC failure. The objective of the study is to explore the traits of acquired drug resistant TB emergence and evaluate their impacts on treatment outcomes. Methods A prospective observational study was performed on newly admitted smear positive pulmonary TB (PTB) cases without drug resistance pretreatment treated with SCC under China’s National TB Control Program (NTP) condition from 2008 to 2010. Enrolled cases were followed up through sputum smear, culture and drug susceptibility testing (DST) at the end of 1, 2, and 5 months after treatment initiation. The effect factors of early or late emergence of acquired drug resistant TB , such as acquired drug resistance patterns, the number of acquired resistant drugs and previous treatment history were investigated by multivariate logistic regression; and the impact of acquired drug resistant TB emergence on treatment failure were further evaluated. Results Among 1671 enrolled new and previously treated cases with SCC, 62 (3.7 %) acquired different patterns of drug resistant TB at early period within 2 months or later around 3–5 months of treatment. Previously treated cases were more likely to develop acquired multi-drug resistant TB (MDR-TB) (OR, 3.8; 95 %CI, 1.4–10.4; P = 0.015). Additionally, acquired MDR-TB cases were more likely to emerge at later period around 3-5 months after treatment starting than that of non-MDR-TB mainly appeared within 2 months (OR, 8.3; 95 %CI, 1.7–39.9; P = 0.008). Treatment failure was associated with late acquired drug resistant TB emergence (OR, 25.7; 95 %CI, 4.3–153.4; P < 0.001) with the reference of early acquired drug resistant TB emergence. Conclusions This study demonstrates that later development of acquired drug resistant TB during SCC is liable to suffer treatment failure and acquired MDR-TB pattern may be one of the possible causes. Electronic supplementary material The online version of this article (doi:10.1186/s12890-016-0187-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jingtao Gao
- Clinical Center on Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Yan Ma
- Clinical Center on Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Jian Du
- Clinical Center on Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Guofeng Zhu
- State Key Laboratory for Molecular Virology and Genetic Engineering, Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shouyong Tan
- Department of TB Control, Guangzhou Chest Hospital, Guangzhou, Guangdong, China
| | - Yanyong Fu
- Department of TB Control, Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Liping Ma
- Department of TB Control, Henan Center for Disease Control and Prevention, Zhengzhou, Henan, China
| | - Lianying Zhang
- Department of TB Control, Hebei Center for Disease Control and Prevention, Shijiazhuang, Hebei, China
| | - Feiying Liu
- Department of TB Control, Guangxi Center for Disease Control and Prevention, Nanning, Guangxi, China
| | - Daiyu Hu
- Department of TB Control, Chongqing Anti-tuberculosis Institute, Chongqing, China
| | - Yanling Zhang
- Department of TB Control, Yunnan Center for Disease Control and Prevention, Kunming, Yunnan, China
| | - Xiangqun Li
- Department of TB Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Liang Li
- Clinical Center on Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China.
| | - Qi Li
- Clinical Center on Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China.
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Islam QS, Islam MA, Islam S, Ahmed SM. Prevention and control of tuberculosis in workplaces: how knowledgeable are the workers in Bangladesh? BMC Public Health 2015; 15:1291. [PMID: 26703074 PMCID: PMC4690220 DOI: 10.1186/s12889-015-2622-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 12/16/2015] [Indexed: 12/04/2022] Open
Abstract
Background The National Tuberculosis (TB) Control Programme (NTP) of Bangladesh succeeded in achieving the dual targets of 70 % case detection and 85 % treatment completion as set by the World Health Organization. However, TB prevention and control in work places remained largely an uncharted area for NTP. There is dearth of information regarding manufacturing workers’ current knowledge, attitudes and practices (KAP) on pulmonary TB which is essential for designing a TB prevention and control programme in the workplaces. This study aimed to fill-in this knowledge gap. Methods This cross-sectional survey was done in multiple workplaces like garment factories, jute mills, bidi/tobacco factories, flour mills, and steel mills using a multi-stage sampling procedure. Data on workers’ KAP related to pulmonary TB were collected from 4800 workers in face-to-face interview. Results The workers were quite knowledgeable about symptoms of pulmonary TB (72 %) and free- of-cost sputum test (86 %) and drug treatment (88 %), but possessed superficial knowledge regarding causation (4 %) and mode of transmission (48 %). Only 11 % knew about preventive measures e.g., taking BCG vaccine and/or refraining from spitting here and there. Knowledge about treatment duration (43 %) and consequences of incomplete treatment (11 %) was poor. Thirty-one percent were afraid of the disease, 21 % would feel embarrassed (and less dignified) if they would have TB, and 50 % were afraid of isolation if neighbours would come to know about it. Workers with formal education (AOR 1.92; 95 % CI 1.61, 2.29) and exposure to community health workers (CHW) (AOR 31.60; 95 % CI 18.75, 53.35) were more likely to have TB knowledge score ≥ mean. Workers with knowledge score ≥ mean (AOR = 1.91; 95 % CI:1.44, 2.53) and exposure to CHWs either alone (AOR = 42.4; 95 % CI: 9.94, 180.5) or in combination with print media (AOR = 37.35; 95 % CI: 9.1, 180.5) were more likely to go to DOTS centre for treatment . Only around 43 % had sputum examination despite having chronic cough of ≥ 3 weeks duration. Conclusion The workers had inadequate knowledge regarding its causation, transmission and prevention which may interfere with appropriate treatment-seeking for chronic cough including sputum test. NTP needs to be cognizant of these factors while designing a workplace TB prevention and control programme for Bangladesh.
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Affiliation(s)
| | - Md Akramul Islam
- Health, Nutrition and Population Programme, BRAC, Dhaka, Bangladesh.
| | - Shayla Islam
- Health, Nutrition and Population Programme, BRAC, Dhaka, Bangladesh.
| | - Syed Masud Ahmed
- Centre of Excellence for Universal Health Coverage James P Grant School of Public Health, BRAC University, 68 Shahid Tajuddin Ahmed Sharani, 5th Floor(Level-6), ICDDR,B Building Mohakhali, Dhaka, 1212, Bangladesh.
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Mohd Shariff N, Shah SA, Kamaludin F. Previous treatment, sputum-smear nonconversion, and suburban living: The risk factors of multidrug-resistant tuberculosis among Malaysians. Int J Mycobacteriol 2015; 5:51-8. [PMID: 26927990 DOI: 10.1016/j.ijmyco.2015.11.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 11/09/2015] [Accepted: 11/12/2015] [Indexed: 10/22/2022] Open
Abstract
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.
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Affiliation(s)
- Noorsuzana Mohd Shariff
- Community Health Department, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia; Advanced Medical and Dental Institute, Universiti Sains Malaysia, Pulau Pinang, Malaysia.
| | - Shamsul Azhar Shah
- Community Health Department, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Fadzilah Kamaludin
- Office of Deputy Director General of Health Malaysia, Ministry of Health Malaysia, Putrajaya, Malaysia
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Rifat M, Hall J, Oldmeadow C, Husain A, Milton AH. Health system delay in treatment of multidrug resistant tuberculosis patients in Bangladesh. BMC Infect Dis 2015; 15:526. [PMID: 26573825 PMCID: PMC4647619 DOI: 10.1186/s12879-015-1253-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 10/27/2015] [Indexed: 11/23/2022] Open
Abstract
Background Bangladesh is one of the 27 high burden countries for multidrug resistant tuberculosis listed by the World Health Organization. Delay in multidrug resistant tuberculosis treatment may allow progression of the disease and affect the attempts to curb transmission of drug resistant tuberculosis. The main objective of this study was to investigate the health system delay in multidrug resistant tuberculosis treatment in Bangladesh and to explore the factors related to the delay. Methods Information related to the delay was collected as part of a previously conducted case–control study. The current study restricts analysis to patients with multidrug resistant tuberculosis who were diagnosed using rapid diagnostic methods (Xpert MTB/RIF or the line probe assay). Information was collected by face-to-face interviews and through record reviews from all three Government hospitals providing multidrug resistant tuberculosis services, from September 2012 to April 2013. Multivariable regression analysis was performed using Bootstrap variance estimators. Definitions were as follows: Provider delay: time between visiting a provider for first consultation on MDR-TB related symptom to visiting a designated diagnostic centre for testing; Diagnostic delay: time from date of diagnostic sample provided to date of result; Treatment initiation delay: time between the date of diagnosis and date of treatment initiation; Health system delay: time between visiting a provider to start of treatment. Health system delay was derived by adding provider delay, diagnostic delay and treatment initiation delay. Results The 207 multidrug resistant tuberculosis patients experienced a health system delay of median 7.1 weeks. The health system delay consists of provider delay (median 4 weeks), diagnostic delay (median 5 days) and treatment initiation delay (median 10 days). Health system delay (Coefficient: 37.7; 95 %; CI 15.0–60.4; p 0.003) was associated with the visit to private practitioners for first consultation. Conclusions Diagnosis time for multidrug resistant tuberculosis was fast using the rapid tests. However, some degree of delay was present in treatment initiation, after diagnosis. The most effective way to reduce health system delay would be through strategies such as engaging private practitioners in multidrug resistant tuberculosis control.
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Affiliation(s)
- Mahfuza Rifat
- School of Medicine and Public Health, Faculty of Health and Medicine, the University of Newcastle, HMRI Building Lot 1 Kookaburra Circuit, New Lambton Heights, Newcastle, NSW, 2305, Australia. .,BRAC, Dhaka, Bangladesh.
| | - John Hall
- School of Medicine and Public Health, Faculty of Health and Medicine, the University of Newcastle, HMRI Building Lot 1 Kookaburra Circuit, New Lambton Heights, Newcastle, NSW, 2305, Australia.
| | - Christopher Oldmeadow
- School of Medicine and Public Health, Faculty of Health and Medicine, the University of Newcastle, HMRI Building Lot 1 Kookaburra Circuit, New Lambton Heights, Newcastle, NSW, 2305, Australia.
| | - Ashaque Husain
- National Tuberculosis Control Programme, Directorate General of Health Services, Dhaka, Bangladesh.
| | - Abul Hasnat Milton
- School of Medicine and Public Health, Faculty of Health and Medicine, the University of Newcastle, HMRI Building Lot 1 Kookaburra Circuit, New Lambton Heights, Newcastle, NSW, 2305, Australia.
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Rifat M, Hall J, Oldmeadow C, Husain A, Hinderaker SG, Milton AH. Factors related to previous tuberculosis treatment of patients with multidrug-resistant tuberculosis in Bangladesh. BMJ Open 2015; 5:e008273. [PMID: 26351185 PMCID: PMC4563275 DOI: 10.1136/bmjopen-2015-008273] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Previous 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 multidrug resistant in Bangladesh. DESIGN We previously conducted a large case-control study to identify risk factors for developing MDR-TB in Bangladesh. Patients who had a history of previous TB treatment, either MDR-TB or non-MDR-TB, were interviewed about their previous treatment episode. This study restricts analysis to the strata of patients who have been previously treated for TB. Information was collected through face-to-face interviews and record reviews. Unadjusted and multivariable logistic regression was used for data analysis. SETTING Central-level, district-level and subdistrict-level hospitals in rural and urban Bangladesh. RESULTS The strata of previously treated patients include a total of 293 patients (245 current MDR-TB; 48 non-MDR-TB). Overall, 54% of patients received previous TB treatment more than once, and all of these patients were multidrug resistant. Patients with MDR-TB were more likely to have experienced the following factors: incomplete treatment (OR 4.3; 95% CI 1.7 to 10.6), adverse reactions due to TB treatment (OR 8.2; 95% CI 3.2 to 20.7), hospitalisation for symptoms associated with TB (OR 16.9; CI 1.8 to 156.2), DOTS (directly observed treatment, short-course) centre as treatment unit (OR 6.4; CI 1.8 to 22.8), supervised treatment (OR 3.8; CI 1.6 to 9.5); time-to-treatment centre (OR 0.984; CI 0.974 to 0.993). CONCLUSIONS Incomplete treatment, hospitalisation for TB treatment and adverse reaction are the factors related to previous TB treatment of patients with MDR-TB. Although the presence of supervised treatment (DOT), less time-to-treatment centres and being treated in DOTS centres were relatively higher among the patients with MDR-TB compared with patients without MDR-TB, these findings include information of their most recent TB treatment episode only. Most (64.5%) of the patients with MDR-TB had received TB treatment more than once.
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Affiliation(s)
- Mahfuza Rifat
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Health Nutrition and Population Programme, BRAC, Dhaka, Bangladesh
| | - John Hall
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Christopher Oldmeadow
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Ashaque Husain
- National Tuberculosis Control Programme, Dhaka, Bangladesh
| | - Sven Gudmund Hinderaker
- The Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Abul Hasnat Milton
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
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Liu YX, Pang CK, Liu Y, Sun XB, Li XX, Jiang SW, Xue F. Association between Multidrug-Resistant Tuberculosis and Risk Factors in China: Applying Partial Least Squares Path Modeling. PLoS One 2015; 10:e0128298. [PMID: 26020921 PMCID: PMC4447294 DOI: 10.1371/journal.pone.0128298] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 04/25/2015] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Multidrug-resistant tuberculosis (MDR-TB) resulting from various factors has raised serious public health concerns worldwide. Identifying the ecological risk factors associated with MDR-TB is critical to its prevention and control. This study aimed to explore the association between the development of MDR-TB and the risk factors at the group-level (ecological risk factors) in China. METHODS Data on MDR-TB in 120 counties were obtained from the National Tuberculosis Information Management System, and data on risk-factor variables were extracted from the Health Statistical Yearbook, provincial databases, and the meteorological bureau of each province (municipality). Partial Least Square Path Modeling was used to detect the associations. RESULTS The median proportion of MDR-TB in new TB cases was 3.96% (range, 0-39.39%). Six latent factors were extracted from the ecological risk factors, which explained 27.60% of the total variance overall in the prevalence of MDR-TB. Based on the results of PLS-PM, TB prevention, health resources, health services, TB treatment, TB detection, geography and climate factors were all associated with the risk of MDR-TB, but socioeconomic factors were not significant. CONCLUSIONS The development of MDR-TB was influenced by TB prevention, health resources, health services, TB treatment, TB detection, geography and climate factors. Such information may help us to establish appropriate public health intervention strategies to prevent and control MDR-TB and yield benefits to the entire public health system in China.
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Affiliation(s)
- Yun-Xia Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan, China
| | - Chun-Kun Pang
- Institute Office, Shandong Academy of Medical Science, Jinan, China
| | - Yanxun Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan, China
| | - Xiu-Bin Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan, China
| | - Xin-Xu Li
- Institute for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shi-Wen Jiang
- Institute for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Fuzhong Xue
- Department of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan, China
- * E-mail:
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