Low Levels of Extensively Drug-resistant Tuberculosis among Multidrug Resistant Tuberculosis Isolates and Their Relationship to Risk Factors: Surveillance in Tehran, Iran; 2006 to 2014

다국어 초록 (Multilingual Abstract)

Objectives: Extensively drug-resistant tuberculosis (XDR-TB) is more expensive and difficult to treat than multidrug-resistant tuberculosis (MDR-TB), and outcomes for patients are much worse; therefore, it is important that clinicians understand the magnitude and distribution of XDR-TB. We conducted a retrospective study to compare the estimated incidence of and risk factors for M/XDR-TB with those of susceptible TB controls.
Methods: Sputum culture and drug susceptibility testing (DST) were performed in patients with known or suspected TB. Strains that were identified as MDR were subjected to DST for secondline drugs using the proportion method.
Results: Among 1,442 TB patients (mean age, 46.48 ± 21.24 years) who were culture-positive for Mycobacterium tuberculosis, 1,126 (78.1%) yielded isolates that were resistant to at least one first-line drug; there were 33 isolates (2.3%) of MDR-TB, of which three (0.2%) were classified as XDR-TB. Ofloxacin resistance was found in 10 (0.7%) isolates. Women were 15% more likely than men to yield M/XDR-TB isolates, but this difference was not significant. In a multivariate analysis comparing susceptible TB with X/MDR-TB, only one variable—the number of previous treatment regimens—was associated with MDR (odds ratio, 1.06; 95% confidence interval, 1.14–21.2).
Conclusion: The burden of M/XDR-TB cases is not sizeable in Iran. Nonetheless, strategies must be implemented to identify and cure patients with pre-XDR-TB before they develop XDR-TB.
Our results provide a greater understanding of the evolution and spread of M/XDR-TB in an environment where drug-resistant TB has a low incidence.

참고문헌 (Reference)

1 World Health Organization, "Systematic screening for active tuberculosis:principles and recommendations; Document no 2013 (WHO/HTM/TB/2013b.04)" World Health Organization

2 Matteo Zignol, "Surveillance of anti-tuberculosis drug resistance in the world: an updated analysis, 2007–2010" WHO Press 90 (90): 111-119D, 2012

3 Fok A, "Risk factors for clustering of tuberculosis cases : a systematic review of population-based molecular epidemiology studies" 12 : 480-492, 2008

4 CUI HUA LIU, "Risk factors associated with fluoroquinolone-resistant tuberculosis in a Beijing tuberculosis referral hospital" Wiley-Blackwell 16 (16): 918-925, 2011

5 Shenjie Tang, "Risk Factors for Poor Treatment Outcomes in Patients with MDR-TB and XDR-TB in China: Retrospective Multi-Center Investigation" Public Library of Science (PLoS) 8 (8): e82943-, 2013

6 Wei Chen, "Pulmonary Tuberculosis Incidence and Risk Factors in Rural Areas of China: A Cohort Study" Public Library of Science (PLoS) 8 (8): e58171-, 2013

7 Kent PT, "Public health mycobacteriology: a guide for a level III laboratory"

8 Metanat M, "Prevalence of multidrug-resistant and extensively drug-resistant tuberculosis in patients with pulmonary tuberculosis in Zahedan, southeastern Iran" 14 : 53-55, 2012

9 Tracy Dalton, "Prevalence of and risk factors for resistance to second-line drugs in people with multidrug-resistant tuberculosis in eight countries: a prospective cohort study" Elsevier BV 380 (380): 1406-1417, 2012

10 D Ulmasova, "Multidrug-resistant tuberculosis in Uzbekistan: results of a nationwide survey, 2010 to 2011" European Centre for Disease Control and Prevention (ECDC) 18 (18): 20609-, 2013

11 Alena Skrahina, "Multidrug-resistant tuberculosis in Belarus: the size of the problem and associated risk factors" WHO Press 91 (91): 36-45, 2013

12 World Health Organization, "Multidrug and extensively drugresistant TB (M/XDR-TB): 2010 global report on surveillance and response; Document no 2010 (WHO/HTM/TB/2010.3)" World Health Organization

13 World Health Organization, "Guidelines for drug susceptibility testing for second line anti- tuberculosis drugs for DOTS-plus" World Health Organization

14 World Health Organization, "Global tuberculosis report; Document 2013 (WHO/HTM/TB/2004.343)" World Health Organization

15 World Health Organization, "Global tuberculosis control 2011;Document no 2012 (WHO/HTM/TB/2011.16)" World Health Organization

16 Centers for Disease Control and Prevention (CDC), "Extensively drug-resistant tuberculosis--United States, 1993-2006" 56 : 250-253, 2007

17 Mohammad R. Masjedi, "Extensively drug-resistant tuberculosis treatment outcome in Iran: a case series of seven patients" Elsevier BV 14 (14): e399-e402, 2010

18 Mohamad Reza Masjedi, "Extensively Drug‐Resistant Tuberculosis: 2 Years of Surveillance in Iran" Oxford University Press (OUP) 43 (43): 841-847, 2006

19 Ministry of Health; Center for Leprosy and Tuberculosis Diseases, "Estimates of tuberculosis incidence in Iran" Ministry of Health

20 Reechaipichitkul W, "Drug susceptibility patterns of Mycobacterium tuberculosis and clinical outcomes of drugresistant tuberculosis at Srinagarind Hospital, a tertiary care center in northeastern Thailand" 42 : 1154-1162, 2011

21 Leung CC, "Diabetic control and risk of tuberculosis: a cohort study" 167 : 1486-1494, 2008

22 Catherine R Stevenson, "Diabetes and tuberculosis: the impact of the diabetes epidemic on tuberculosis incidence" Springer Nature 7 (7): 2007

23 Yoshiro Murase, "Clonal Expansion of Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis, Japan" Centers for Disease Control and Prevention (CDC) 16 (16): 948-954, 2010

24 World Health Organization, "Anti-tuberculosis drug resistant in the world. Fourth Global Reprot Report; The WHO/IUATLD Global Project on Anti-tuberculosis" World Health Organization 2008

25 Ershova JV, "Acquired resistance to second-line drugs among persons with tuberculosis in the United States" 55 : 1600-1607, 2012