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

Autor: Joy Sarojini Michael, Peter Daley, Alka Ganesh, P. Chordia, Dilip Mathai, Veeraraghavan Balaji, Alok Azad Anand, Ige Abraham George, Kurien Thomas, K. R. John, Rani Diana Sahni, Thambu David Sudarsanam
Rok vydání: 2009
Předmět:
Adult
Male
Risk
medicine.medical_specialty
Tuberculosis
Adolescent
Extensively Drug-Resistant Tuberculosis
Antitubercular Agents
lcsh:Medicine
India
Public Health and Epidemiology/Infectious Diseases
Drug resistance
Tertiary referral hospital
Pharmacotherapy
Antibiotic resistance
Risk Factors
Internal medicine
Tuberculosis
Multidrug-Resistant
medicine
Humans
lcsh:Science
Retrospective Studies
Multidisciplinary
Infectious Diseases/Antimicrobials and Drug Resistance
business.industry
Multi-drug-resistant tuberculosis
lcsh:R
Extensively drug-resistant tuberculosis
Microbiology/Medical Microbiology
Retrospective cohort study
Mycobacterium tuberculosis
Public Health and Epidemiology/Global Health
Middle Aged
medicine.disease
Hospitals
Surgery
Infectious Diseases
Infectious Diseases/Neglected Tropical Diseases
Streptomycin
lcsh:Q
Female
business
Fluoroquinolones
Research Article
Zdroj: PLoS ONE
PLoS ONE, Vol 5, Iss 3, p e9527 (2010)
ISSN: 1932-6203
Popis: BACKGROUND: India has a high burden of drug resistant TB, although there are few data on XDR-TB. Although XDR-TB has existed previously in India, the definition has not been widely applied, and surveillance using second line drug susceptibility testing has not been performed. Our objective was to analyze clinical and demographic risk factors associated with isolation of MDR and XDR TB as compared to susceptible controls, at a tertiary center. METHODOLOGY/FINDINGS: Retrospective chart review based on positive cultures isolated in a high volume mycobacteriology laboratory between 2002 and 2007. 47 XDR, 30 MDR and 117 susceptible controls were examined. Drug resistant cases were less likely to be extrapulmonary, and had received more previous treatment regimens. Significant risk factors for XDR-TB included residence outside the local state (OR 7.43, 3.07-18.0) and care costs subsidized (OR 0.23, 0.097-0.54) in bivariate analysis and previous use of a fluoroquinolone and injectable agent (other than streptomycin) (OR 7.00, 95% C.I. 1.14-43.03) and an initial treatment regimen which did not follow national guidelines (OR 5.68, 1.24-25.96) in multivariate analysis. Cavitation and HIV did not influence drug resistance. CONCLUSIONS/SIGNIFICANCE: There is significant selection bias in the sample available. Selection pressure from previous treatment and an inadequate initial regimen increases risk of drug resistance. Local patients and those requiring financial subsidies may be at lower risk of XDR-TB.
Databáze: OpenAIRE
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