Low Level of Extensively Drug-resistant Tuberculosis Among MDR-TB Isolates and its Relationship to Risk Factors: Surveillance in Tehran-Iran, 2006–2014

Uzbekistan has a high burden of drug-resistant tuberculosis (TB). Although conventional treatment for multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) has been available since 2013, there has been no systematic documentation about its use and effectiveness. We therefore documented at national level the trends, characteristics, and outcomes of patients with drug-resistant TB enrolled for treatment from 2013–2018 and assessed risk factors for unfavorable treatment outcomes (death, failure, loss to follow-up, treatment continuation, change to XDR-TB regimen) in patients treated in Tashkent city from 2016–2017. This was a cohort study using secondary aggregate and individual patient data. Between 2013 and 2018, MDR-TB numbers were stable between 2347 and 2653 per annum, while XDR-TB numbers increased from 33 to 433 per annum. At national level, treatment success (cured and treatment completed) for MDR-TB decreased annually from 63% to 57%, while treatment success for XDR-TB increased annually from 24% to 57%. On multivariable analysis, risk factors for unfavorable outcomes, death, and loss to follow-up in drug-resistant TB patients treated in Tashkent city included XDR-TB, male sex, increasing age, previous TB treatment, alcohol abuse, and associated comorbidities (cardiovascular and liver disease, diabetes, and HIV/AIDS). Reasons for these findings and programmatic implications are discussed.

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Risk factors of Multidrug Resistant Tuberculosis in central Nepal: A pilot study

Kathmandu University Medical Journal ◽

10.3126/kumj.v8i4.6238 ◽

2012 ◽

Vol 8 (4) ◽

pp. 392-397 ◽

Cited By ~ 6

Author(s):

S B Marahatta ◽

J Kaewkungwal ◽

P Ramasoota ◽

P Singhasivanon

Keyword(s):

Risk Factors ◽

Social Stigma ◽

Smoking Habit ◽

Drug Resistant ◽

Drug Resistant Tuberculosis ◽

Resistant Tuberculosis ◽

Multi Drug Resistant Tuberculosis ◽

National Tuberculosis ◽

Mdr Tb ◽

History Of

Introduction Tuberculosis is the most widespread infectious disease in Nepal and poses a serious threat to the health and development of the country. Incidences of drug resistant tuberculosis in Nepal are increasing and this tuberculosisis a major threat to successfully controlling tuberculosis . Objective The general objective of the study was to assess the risk factors of multi-drug resistant tuberculosis among the patients attending the National Tuberculosis Centre, Bhaktpur Nepal. Methods An observational study/ case-control study with a Atotal number of 55 multi-drug resistant tuberculosis cases and 55 controls. The study was conducted among the patient attending in the National Tuberculosis Centre , Bhaktpur Nepal for six months, between May–October 2010. sImulti-drug resistant tuberculosis wasThe collected data was analysed in SPSS 11.5 version. The association between categorical variables were analysed by chi-square tests, OR and their 95% CI were measured. Results The total number of patients used for the study was 110, of which among them 55 were cases and 55 were controls . Our study revealed that there were significant associations between history of prior TB MDR-TB OR =2.799 (95 % CI 1.159 to 6.667) (p=0.020); smoking habit OR =2.350 and (95%CI 1.071 to 5.159) (p=0.032); social stigma social stigma OR 2.655 (95%CI r 1.071 to 5.159) (p=0.013); knowledge on MDR-TB OR =9.643 (95% CI 3.339 to 27.846) (p < 0.001)and knowledge on DOTS Plus OR=16.714 (95% CI is ranging from 4.656 to 60.008) (p< 0.001). However, there was no association found between alcohol drinking habits and ventilation in the room. Conclusion Our study revealed that there were significant associations between history of prior tuberculosis, smoking habit social stigma social stigma, knowledge on multi-drug resistant tuberculosis and knowledge on DOTS Plus with multi-drug resistant tuberculosis However there was no association between alcohol drinking habit and ventilation in room with multi-drug resistant tuberculosis. http://dx.doi.org/10.3126/kumj.v8i4.6238 Kathmandu Univ Med J 2010;8(4):392-7

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An Epidemiological Study to Find out Risk Factors of Multi Drugs Resistance Tuberculosis in Nepal

SAARC Journal of Tuberculosis Lung Diseases and HIV/AIDS ◽

10.3126/saarctb.v14i2.19335 ◽

2018 ◽

Vol 14 (2) ◽

pp. 31-38

Author(s):

R. P. Bichha ◽

K. K. Jha ◽

V. S. Salhotra ◽

A. P. Weerakoon ◽

K. B. Karki ◽

...

Keyword(s):

Risk Factors ◽

Nuclear Family ◽

Previous History ◽

Case Control ◽

Drug Resistant ◽

Tuberculosis Control ◽

Drug Resistant Tuberculosis ◽

Resistant Tuberculosis ◽

Mdr Tb ◽

History Of

Introduction: Drug resistant tuberculosis is a threat to tuberculosis control worldwide. Previous anti- tuberculosis treatment is a widely reported risk factor for multi drug resistant tuberculosis (MDR-TB), whereas other risk factors are less well described. In Nepal National Tuberculosis Control Programme initiated DOTSPLUS Pilot project from September 2005 using standardized treatment regimen.Objective: To explore the risk factors for MDR-TB in Nepal.Methodology: Institution based matched case control study with a case: control ratio of 1:2 was carried out in three regions of Nepal. Fifty five cases and 110 controls were selected. Current MDR-TB patients on treatment from DOTS–Plus clinic were enrolled as cases. Controls were age, sex matched cured TB patients and who had completed treatment either from the same centre or any DOTS Centre adjacent to that DOTS Plus Centre. Data was collected by a trained research assistant using interviewer administered structured questionnaire. Matched analysis was done using SPSS 16 version. Confounding effects were controlled by using matching, matched analysis and regression analysis.Results: In matched analysis following were the significant risk factors for MDR-TB in Nepal.(1) HIV Sero positivity (OR 15.9, CI 1.9- 133.0) (2) Travel cost more than 50 NRs per day (OR 6.5, CI 2.4- 9.8) (3) Contact history of TB (OR 3.8, CI 2.2- 6.6) (4) Living in a nuclear family (OR 6.0, CI 2.6- 13.9)(5) Non adherence to DOTS (OR 18.6, CI 2.27- 151.0) (6) Distance to treatment centre more than 5 Km ( OR 3.9, CI 1.5- 10.) (7) Previous history of TB ( OR 12.0, CI 5.4 -26.5)(8) Living in a rural area (OR 4, CI 2.1- 8.5) (9) Unmarried (Crude OR 3.3,CI 1.6- 6.8) (10) Un-employment (OR 3.4,CI 1.6-7.6)(11) Living in a rented house (OR 3.5, CI 1.77- 3.67) (12) Single bed room (OR 2.8, CI 1.13- 6.9). Using muti-variate analysis except living in a rented house and single bed room other variables were positive significant predictors for MDR –TB in Nepal.Conclusions: Many risk factors were related to the DOTS. Strengthening of DOTS programme to tackle the identified risk factors can reduce the MDR –TB burden in Nepal.SAARC Journal of Tuberculosis, Lung Diseases and HIV/AIDS, Vol. 14, No. 2, 2017, Page: 31-38

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Cost-effectiveness of bedaquiline, pretomanid and linezolid for treatment of extensively drug-resistant tuberculosis in South Africa, Georgia and the Philippines

BMJ Open ◽

10.1136/bmjopen-2021-051521 ◽

2021 ◽

Vol 11 (12) ◽

pp. e051521

Author(s):

Gabriela Beatriz Gomez ◽

Mariana Siapka ◽

Francesca Conradie ◽

Norbert Ndjeka ◽

Anna Marie Celina Garfin ◽

...

Keyword(s):

South Africa ◽

Cost Effectiveness ◽

Standard Of Care ◽

The Philippines ◽

List Price ◽

Drug Resistant ◽

Drug Resistant Tuberculosis ◽

Resistant Tuberculosis ◽

Extensively Drug Resistant ◽

Mdr Tb

ObjectivesPatients with highly resistant tuberculosis have few treatment options. Bedaquiline, pretomanid and linezolid regimen (BPaL) is a new regimen shown to have favourable outcomes after six months. We present an economic evaluation of introducing BPaL against the extensively drug-resistant tuberculosis (XDR-TB) standard of care in three epidemiological settings.DesignCost-effectiveness analysis using Markov cohort model.SettingSouth Africa, Georgia and the Philippines.ParticipantsXDR-TB and multidrug-resistant tuberculosis (MDR-TB) failure and treatment intolerant patients.InterventionsBPaL regimen.Primary and secondary outcome measures(1) Incremental cost per disability-adjusted life years averted by using BPaL against standard of care at the Global Drug Facility list price. (2) The potential maximum price at which the BPaL regimen could become cost neutral.ResultsBPaL for XDR-TB is likely to be cost saving in all study settings when pretomanid is priced at the Global Drug Facility list price. The magnitude of these savings depends on the prevalence of XDR-TB in the country and can amount, over 5 years, to approximately US$ 3 million in South Africa, US$ 200 000 and US$ 60 000 in Georgia and the Philippines, respectively. In South Africa, related future costs of antiretroviral treatment (ART) due to survival of more patients following treatment with BPaL reduced the magnitude of expected savings to approximately US$ 1 million. Overall, when BPaL is introduced to a wider population, including MDR-TB treatment failure and treatment intolerant, we observe increased savings and clinical benefits. The potential threshold price at which the probability of the introduction of BPaL becoming cost neutral begins to increase is higher in Georgia and the Philippines (US$ 3650 and US$ 3800, respectively) compared with South Africa (US$ 500) including ART costs.ConclusionsOur results estimate that BPaL can be a cost-saving addition to the local TB programmes in varied programmatic settings.

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Extensively Drug-Resistant Tuberculosis in South Korea: Risk Factors and Treatment Outcomes among Patients at a Tertiary Referral Hospital

Clinical Infectious Diseases ◽

10.1086/524017 ◽

2008 ◽

Vol 46 (1) ◽

pp. 42-49 ◽

Cited By ~ 63

Author(s):

C. Y. Jeon ◽

S. H. Hwang ◽

J. H. Min ◽

D. R. Prevots ◽

L. C. Goldfeder ◽

...

Keyword(s):

Risk Factors ◽

South Korea ◽

Treatment Outcomes ◽

Referral Hospital ◽

Drug Resistant ◽

Tertiary Referral ◽

Tertiary Referral Hospital ◽

Drug Resistant Tuberculosis ◽

Resistant Tuberculosis ◽

Extensively Drug Resistant

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Emergence of Low-level Delamanid and Bedaquiline Resistance During Extremely Drug-resistant Tuberculosis Treatment

Clinical Infectious Diseases ◽

10.1093/cid/ciz074 ◽

2019 ◽

Vol 69 (7) ◽

pp. 1229-1231 ◽

Cited By ~ 16

Author(s):

Silke Polsfuss ◽

Sabine Hofmann-Thiel ◽

Matthias Merker ◽

David Krieger ◽

Stefan Niemann ◽

...

Keyword(s):

Multidrug Resistant ◽

New Drugs ◽

Tuberculosis Treatment ◽

Drug Resistant ◽

Drug Resistant Tuberculosis ◽

Low Level ◽

Resistant Tuberculosis ◽

Extensively Drug Resistant

Abstract Two new drugs, delamanid and bedaquiline, have recently been approved for treatment of multidrug-resistant and extensively drug-resistant (XDR) tuberculosis. Here, we report a case of clofazimine, bedaquiline, and low-level delamanid resistances acquired during treatment of a patient with XDR tuberculosis.

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Evolving rifampicin and isoniazid mono-resistance in a high multidrug-resistant and extensively drug-resistant tuberculosis region: a retrospective data analysis

BMJ Open ◽

10.1136/bmjopen-2019-031663 ◽

2019 ◽

Vol 9 (11) ◽

pp. e031663

Author(s):

Nomonde Ritta Mvelase ◽

Yusentha Balakrishna ◽

Keeren Lutchminarain ◽

Koleka Mlisana

Keyword(s):

South Africa ◽

Diagnostic Algorithm ◽

Multidrug Resistant ◽

Continuous Phase ◽

Drug Resistant ◽

Drug Resistant Tuberculosis ◽

Resistant Tuberculosis ◽

Extensively Drug Resistant ◽

Kwazulu Natal ◽

Mdr Tb

ObjectivesSouth Africa ranks among the highest drug-resistant tuberculosis (DR-TB) burdened countries in the world. This study assessed the changes in resistance levels in culture confirmed Mycobacterium tuberculosis (MTB) in the highest burdened province of South Africa during a period where major changes in diagnostic algorithm were implemented.SettingThis study was conducted at the central academic laboratory of the KwaZulu-Natal province of South Africa.ParticipantsWe analysed data for all MTB cultures performed in the KwaZulu-Natal province between 2011 and 2014. The data were collected from the laboratory information system.ResultsOut of 88 559 drug susceptibility results analysed, 18 352 (20.7%) were resistant to rifampicin (RIF) and 19 190 (21.7%) showed resistance to isoniazid (INH). The proportion of rifampicin resistant cases that were mono-resistant increased from 15.3% in 2011 to 21.4% in 2014 while INH mono-resistance (IMR) showed a range between 13.8% and 21.1%. The multidrug-resistant tuberculosis (MDR-TB) rates increased from 18.8% to 23.9% and the proportion of MDR-TB cases that had extensively drug-resistant tuberculosis remained between 10.2% and 11.1%. Most drug resistance was found in females between the ages of 15 and 44 years and the northern districts bordering high MDR-TB regions had the highest MDR-TB rates.ConclusionOur findings show increasing RIF mono-resistance (RMR) and a substantial amount of IMR. This highlights a need for an initial test that detects resistance to both these drugs so as to avoid using RIF monotherapy during continuous phase of treatment in patients with IMR. Furthermore, addition of INH will benefit patients with RMR. Although DR-TB is widespread, HIV and migration influence its distribution; therefore, TB control strategies should include interventions that target these aspects.

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Incidence and Risk Factors for Extensively Drug-Resistant Tuberculosis in Delhi Region

PLoS ONE ◽

10.1371/journal.pone.0055299 ◽

2013 ◽

Vol 8 (2) ◽

pp. e55299 ◽

Cited By ~ 17

Author(s):

Chhavi Porwal ◽

Amit Kaushik ◽

Nayani Makkar ◽

Jayant N. Banavaliker ◽

Mahmud Hanif ◽

...

Keyword(s):

Risk Factors ◽

Drug Resistant ◽

Drug Resistant Tuberculosis ◽

Resistant Tuberculosis ◽

Extensively Drug Resistant

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Prevalence and risk factors of multi-drug resistant tuberculosis in Dalian, China

Journal of International Medical Research ◽

10.1177/0300060516687429 ◽

2017 ◽

Vol 45 (6) ◽

pp. 1779-1786 ◽

Cited By ~ 9

Author(s):

Xin-Tong Lv ◽

Xi-Wei Lu ◽

Xiao-Yan Shi ◽

Ling Zhou

Keyword(s):

Risk Factors ◽

Population History ◽

Drug Resistant ◽

Drug Resistant Tuberculosis ◽

Tb Treatment ◽

Resistant Tuberculosis ◽

Multi Drug Resistant Tuberculosis ◽

Mdr Tb ◽

Previously Treated Patients ◽

Previously Treated

Objectives To investigate the prevalence and risk factors associated with multi-drug resistant tuberculosis (MDR–TB) in Dalian, China. Methods This was a retrospective review of data from patients attending a TB clinic in Dalian, China between 2012 and 2015. Demographic and drug susceptibility data were retrieved from TB treatment cards. Univariate logistic analysis was used to assess the association between risk factors and MDR–TB. Results Among the 3552 patients who were smear positive for Mycobacterium tuberculosis (MTB), 2918 (82.2%) had positive MTB cultures and 1106 (31.1%) had isolates that showed resistance to at least one drug. The overall prevalence of MDR–TB was 10.1% (359/3552; 131/2261 [5.8%] newly diagnosed and 228/1291 [17.7%] previously treated patients). Importantly, 75 extensively drug-resistant TB isolates were detected from 25 newly treated and 50 previously treated patients. In total, 215 (6.1%) patients were infected with a poly-resistant strain of MTB. Previously treated patients and older patients were more likely to develop MDR–TB. Conclusions The study showed a high prevalence of MDR–TB among the study population. History of previous TB treatment and older age were associated with MDR–TB.

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Treatment of Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis in Children: The Role of Bedaquiline and Delamanid

Microorganisms ◽

10.3390/microorganisms9051074 ◽

2021 ◽

Vol 9 (5) ◽

pp. 1074

Author(s):

Francesco Pecora ◽

Giulia Dal Canto ◽

Piero Veronese ◽

Susanna Esposito

Keyword(s):

Adverse Effects ◽

Pediatric Population ◽

Multidrug Resistant ◽

New Drugs ◽

Drug Resistant ◽

Standard Regimen ◽

Drug Resistant Tuberculosis ◽

Resistant Tuberculosis ◽

Extensively Drug Resistant ◽

Mdr Tb

Multidrug-resistant (MDR) tuberculosis (TB) has been emerging at an alarming rate over the last few years. It has been estimated that about 3% of all pediatric TB is MDR, meaning about 30,000 cases each year. Although most children with MDR-TB can be successfully treated, up to five years ago effective treatment was associated with a high incidence of severe adverse effects and patients with extensively drug-resistant (XDR) TB had limited treatment options and no standard regimen. The main objective of this manuscript is to discuss our present knowledge of the management of MDR- and XDR-TB in children, focusing on the characteristics and available evidence on the use of two promising new drugs: bedaquiline and delamanid. PubMed was used to search for all of the studies published up to November 2020 using key words such as “bedaquiline” and “delamanid” and “children” and “multidrug-resistant tuberculosis” and “extensively drug-resistant tuberculosis”. The search was limited to articles published in English and providing evidence-based data. Although data on pediatric population are limited and more studies are needed to confirm the efficacy and safety of bedaquiline and delamanid, their use in children with MDR-TB/XDR-TB appears to have good tolerability and efficacy. However, more evidence on these new anti-TB drugs is needed to better guide their use in children in order to design effective shorter regimens and reduce adverse effects, drug interactions, and therapeutic failure.

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