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Free Content Determinants of drug-resistant tuberculosis: analysis of 11 countries

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Abstract:

SETTING: Eleven countries/territories.

OBJECTIVES: Global information on the determinants of drug-resistant tuberculosis (TB) based on representative data is not available. We therefore studied the relationship between demographic characteristics, prior TB treatment, and human immunodeficiency virus (HIV) infection with anti-tuberculosis drug resistance.

METHODS: Population-based representative data on new and previously treated patients with TB collected within an international drug resistance surveillance network.

RESULTS: Of 9615 patients, 8222 (85.5%) were new cases of TB and 1393 (14.5%) were previously treated cases. Compared with new cases, previously treated cases were significantly more likely to have resistance to one (OR = 2.5, 95%CI 2.1–3.0; P < 0.001), two (OR = 4.6, 95%CI 3.7–5.6; P < 0.001), three (OR = 11.5, 95%CI 8.6–15.3; P < 0.001), and four (OR = 18.5, 95%CI 12.0–28.5; P < 0.001) drugs. An approximately linear increase in the likelihood of having multidrug-resistant tuberculosis (MDR-TB) was observed as the total time (measured in months) of prior anti-tuberculosis treatment increased (P < 0.001, κ2for trend). In multivariate analysis, prior TB treatment for 6–11 months (OR = 7.6, 95%CI 2.6, 22.4; P < 0.001) and ≥12 months (OR 13.7, 95%CI 4.5–41.6; P < 0.001), but not HIV positivity, was associated with MDR-TB.

CONCLUSION: This study shows that prior but ineffective treatment is a strong predictor of drug resistance, and that HIV is not an independent risk factor for MDR-TB. The association between length of treatment and drug resistance may reflect longer treatment as a result of treatment failure in patients with drug resistance; it may also reflect irregular prior treatment for TB, leading to drug resistance.

Keywords: drug resistance; risk factors; tuberculosis

Document Type: Regular Paper

Affiliations: 1: World Health Organization, Communicable Diseases, Geneva, Switzerland 2: Centers for Disease Control and Prevention, Division of TB Elimination, Atlanta, Georgia, United States 3: National Laboratory of Tuberculosis, La Paz, Bolivia 4: Provincial Centre for TB Control, Shandong, PeopleÕs Republic of China 5: Korean Institute of Tuberculosis, Seoul, Republic of Korea 6: National TB Control Programme, Ministry of Health, Maseru, Lesotho 7: National Tuberculosis Centre, Kathmandu, Nepal 8: National Tuberculosis Control Programme, Lima, Peru 9: Ministry of Health, Lisbon, Portugal 10: National Reference Laboratory, National Leprosy/TB Control Programme, Freetown, Sierra Leone 11: Microbiology and Parasitology Service, Vall dÕHebron Hospitals, Barcelona, Spain 12: National TB Control Programme, Ministry of Health, Manzini, Swaziland 13: Medical Research Council, National Tuberculosis Research Programme, South Africa

Publication date: October 1, 2001

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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