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Free Content Rise in rifampicin-monoresistant tuberculosis in Western Cape, South Africa

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SETTING: Brewelskloof Hospital, Western Cape, South Africa.

OBJECTIVES: To verify the perceived increase in rifampicin monoresistant tuberculosis (RMR-TB) in the Cape Winelands-Overberg region and to identify potential risk factors.

DESIGN: A retrospective descriptive study of trends in RMR-TB over a 5-year period (2004–2008), followed by a case-control study of RMR and isoniazid (INH) monoresistant TB cases, diagnosed from April 2007 to March 2009, to assess for risk factors.

RESULTS: The total number of RMR-TB cases more than tripled, from 31 in 2004 to 98 in 2008. The calculated doubling time was 1.63 years (95%CI 1.18–2.66). For the assessment of risk factors, 95 RMR-TB cases were objectively verified on genotypic and phenotypic analysis. Of 108 specimens genotypically identified as RMR cases, 13 (12%) were misidentified, multidrug-resistant TB. On multivariate analysis, previous use of antiretroviral therapy (OR 6.4, 95%CI 1.3–31.8), alcohol use (OR 4.8, 95%CI 2.0–11.3) and age ≥40 years (OR 5.8, 95%CI 2.4–13.6) were significantly associated with RMR-TB.

CONCLUSION: RMR-TB is rapidly increasing in the study setting, particularly among patients with advanced human immunodeficiency virus (HIV) disease. Routine drug susceptibility testing should be considered in all TB-HIV co-infected patients, and absence of INH resistance should be confirmed phenotypically if genotypic RMR-TB is detected.

Keywords: South Africa; monoresistant; rifampicin; tuberculosis

Document Type: Research Article


Affiliations: 1: Department of Interdisciplinary Health Sciences, Clinical Epidemiology, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa 2: Brewelskloof Hospital, Worcester, South Africa 3: Centre for Molecular and Cellular Biology, Stellenbosch University and the South African Medical Research Council, Cape Town, South Africa 4: Massachusetts General Hospital, Boston, Massachusetts, USA 5: Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa 6: National Health Laboratory Services, Cape Town, South Africa 7: Department of Paediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University, South Africa; Desmond Tutu TB Centre, Faculty of Health Sciences, Stellenbosch University, South Africa 8: Department of Medicine and Centre for Infectious Diseases, Faculty of Health Sciences, Stellenbosch University, South Africa; Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA

Publication date: 2012-02-01

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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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