Resistance patterns and trends of extensively drug-resistant tuberculosis: 5-year experience

Abstract

Objective: Extensively drug-resistant tuberculosis (XDR-TB) strains were emerged when multidrug-resistant TB (MDR-TB) was inadequately treated. Inadequate treatment of MDR-TB cases may result in additional resistance especially non-XDR-TB and then XDR-TB. The aim of this study was to know the prevalence, resistance patterns and trends of the XDR-TB strains among the MDR-TB at a tertiary care hospital in Lucknow, India Methods: A total of 430 Mycobacterium isolates were underwent NAP test and TB MPT64 Ag test for the identification of Mycobacterium tuberculosis complex (MTBC). Drug-susceptibility test (DST) was performed over MTBC for the first line drugs by 1% proportion method (Bactec) and for the second-line drugs by 1% proportion method (Lowenstein-Jensen media). The XDR-TB status was further confirmed by line probe assay (GenoType® MTBDRsl assay). Results: Among the 430 isolates of mycobacterium, 365 (84.9%) were MTBC and 139 (38.1%) were MDR-TB respectively. Further 97 MDR-TB from "highly suspected drug resistant-TB (DR-TB)" cases among MDR-TB were tested with second line drugs in which 15 (15.5%) XDR-TB and 82 (84.5%) were non-XDR-TB. Regarding XDR-TB status, using the 1% proportion method a 100% agreement was seen with the GenoType® MTBDRsl assay. Resistance patterns of XDR-TB were as; 10/15 (66.7%) as isoniazid + rifampicin + ciprofloxacin + amikacin resistance and 5/15 (33.3%) as isoniazid + rifampicin + ciprofloxacin + amikacin + kanamycin resistance. Conclusion: The prevalence of XDR-TB was 15.5% among MDR-TB. Hence laboratory testing of "highly suspected drug resistant-TB" isolates should be done for both first and second line drugs simultaneously especially in developing countries.

Keywords

• Mycobacterium tuberculosis, extensively drug-resistant tuberculosis, multi drug-resistance tuberculosis, India

Resistance patterns and trends of extensively drug-resistant tuberculosis: 5-year experience

Öz

Amaç: Genişlemiş drug-rezistan tüberküloz (XDR-TB) suşları multi-drug rezistan tüberküloz (MDR-TB) suşlarının uygunsuz tedavisiyle önem kazandı. Multi-drug rezistan tüberküloz (MDR-TB) suşları ile infekte olguların uygunsuz tedavisi özellikle XDR-TB dışı ve XDR-TB’a yol açabilir. Bu çalışmada Hindistan’ın Luckdown şehrindeki bir üçüncü basamak hastanesinde multidrug-rezistan tüberküloz suşları arasında genişlemiş drug-rezistans paterni ve trendinin araştırılması amaçlandı. Yöntemler: Çalışmada Mycobacteruim tuberculosis complex (MTBC) identifikasyonu için 430 mikobakteri suşu NAP testi ve TB MPT64 Ag testine tabi tutuldu. İlaç duyarlılıklarının belirlenmesinde ilk sıra ilaçlar için % 1 proporsiyon metodu (Bactec) XDR-TB durumu GenoType® MTBDRslassay ile doğrulandı.Bulgular: Toplam 430 mikobakteriden 365’i (% 84,9) MTBC ve 139’u (% 38,1) MDR-TB olarak tanımlandı. Yüksek oranda drug-rezistan-TB (DR-TB) olarak düşünülen 97 MDR-TB suşu ikinci sıra antitüberküloz ilaçlara duyarlılık açısındn test edildiğinde suşlardan 15’i (% 15,5) XDR-TB ve 82’si (% 84,5) ise XDR-TB dışı suşlar idi. XDR-TB suşlarının tamamı %1 proporsiyon testi kullanılarak GenoType® MTBDRsl assay ile doğrulandı. Toplam 15 XDR-TB suşundan 10’u (% 66,7) izoniazid + rifampisin + siprofloksazin + amikasin ve 5’i (% 33,3%) izoniazid + rifampisin + siprofloksazin + amikasin + kanamisin’e dirençli olarak değerlendirildi.Sonuç: Bu çalışmada MDR-TB suşları arasında XDR-TB prevalansı % 15,5 olarak bulunmuştur. Bu yüzden özellikle gelişmekte olan ülkelerde yüksek şüpheli drug-rezistan TB durumunda suşların ilk ve ikinci sıra antitüberküloz ilaçlara duyarlılığının birlikte araştırılması gerektiğini düşünüyoruz

Anahtar Kelimeler

• Mycobacterium tuberculosis, genişlemiş drug-rezistan tüberküloz, multidrug-rezistan tüberküloz, Hindistan

Kaynakça

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