Pattern of resistance to second line anti-tuberculosis drugs and associated risk factors among multidrug-resistant patients of pulmonary tuberculosis from Agra region of Uttar Pradesh, North India
Second line anti-tuberculosis drug in multidrug-resistant TB patients of Uttar Pradesh, North India
Abstract
Present study was aimed to determine the status of second-line anti-TB drug resistance and risk factorsfor extensively drug-resistance (XDR)-tuberculosis among multi-drug resistant (MDR)-tuberculosis patients from Agra region of Uttar Pradesh, North India.A total of 279 MDR-Mycobacterium tuberculosis isolates from pulmonary tuberculosis patients of Agra region of Uttar Pradesh were analyzed for the resistance to second-line anti-TB drugs (SLDs). The demographic, behavioral, clinical and social information was compared with the results of drug susceptibility testing and analyzed statistically. Out of 279 MDR-isolates, 195 (69.89%) isolates were found resistant to at least one of the SLDs. The rates of general resistance to each of the drugs were as follows: kanamycin (42.29%), amikacin (17.92%), levofloxacin (40.14%) and ofloxacin (51.97%). Among the MDR-TB isolates, 53.76, 43.01 and 26.88% isolates were resistant to fluoroquinolone, second line injectable drugs and XDR, respectively. Among the demographic/ clinical variables, occupation, gender and number of family members were associated with the development of XDR-TB in MDR-TB patients of Agra region of Uttar Pradesh(P value: <0.05).Present study has provided baseline information about the risk factors associated with SLDs resistance and XDRamong MDR-TB patients which can be useful to strengthen the implementation of targeted interventions in order to minimize the cases of drug resistance tuberculosis in Uttar Pradesh, North India.
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References
2. India TB report 2020.National tuberculosis Elimination Programme. https://tbcindia.gov.in/showfile.php?lid=3538.
3. Singh N, Singh PK, Singh U, Garg R, Jain A. Fluroquinolone drug resistance among MDR-TB patients increases the risk of unfavourable interim microbiological treatment outcome: An observational study. Journal of Global Antimicrobial Resistance 2021; 24: 40-44.
4. Raizada N, Sachdeva KS, Sreenivas A, Vadera B, Gupta RS, Parmar M, et al. Feasibility of decentralised deployment of Xpert MTB/RIF test at lower level of health system in India. PLoS One 2014; 9: e89301
5. Vestal AL. 1977. Procedures of isolation and identification of mycobacteria. U.S. Department of Health, Education, and Welfare publication no. (CDC) 77-8230, p. 65-98. Centers for Disease Control, Atlanta, Ga.
6. Agrawal D, Udwadia ZF, Rodriguez C, Mehta A. Increasing incidence of fluoroquinolone-resistant Mycobacterium tuberculosis in Mumbai, India. International Journal of Tuberculosis and Lung Disease 2009; 13:79–83.
7. Ramachandran R, Nalini S, Chandrasekar V, Dave PV, Sanghvi AS, Wares F, et al. Surveillance of drug-resistant tuberculosis in the state of Gujarat. India. International Journal of Tuberculosis and Lung Disease 2009; 13(9):1154–60.
8. Sharma SK, George N, Kadhiravan T, Saha PK, Mishra HK, et al. Prevalence of extensively drug- resistant tuberculosis among patients with multidrug- resistant tuberculosis: a retrospective hospital-based study. Indian Journal of Medical Research 2009; 392–395.
9. Porwal C, Kaushik A, Makkar N, Banavaliker JN, Hanif M, et al. Incidence and Risk Factors for Extensively Drug-Resistant Tuberculosis in Delhi Region. PLoS ONE 2013; 8(2): e55299.
10. Singh PK, Jain A. Limited Scope of Shorter Drug Regimen for MDR TB Caused by High Resistance to Fluoroquinolone. Emerging Infectious Diseases2019; 25 (9): 1760-62.
11. Mamatha HG, Shanthi V. Baseline resistance and cross-resistance among fluoroquinolones in multidrug-resistant Mycobacterium tuberculosis isolates at a national reference laboratory in India. Journal of Global Antimicrobial Resistance 2018; 12:5-10.
12. Lakhani JD, Lakhani SJ, Meera S, Sanket P, Sandeep J. Appropriate use of antimicrobial agents in urinary tract infections: Perception of physicians and resident doctors. Journal of Integrated Health Sciences 2019; 7:19-24.
13. Balaji V, Daley P, Anand AA, Sudarsanam T, Michael JS, Sahni RD, et al. Risk factors for MDR and XDR-TB in a tertiary referral hospital in India. PLOS ONE 2010; 5(3):e9527
14. Khanna A, Raj VS, Tarai B, Sood R, Pareek PK, et al. Emergence and Molecular Characterization of Extensively Drug-R Mycobacterium tuberculosis Clinical Isolates from the Delhi Region in India. Antimicrobial Agents and Chemotherapy 2010; 54: 4789–93
15. Alavi SM, Bakhtiyariniya P, Eghtesad M, Salmanzadeh S. Prevalence of pulmonary tuberculosis before and after soil dust in Khuzestan, southwest Iran. Caspian Journal of Internal Medicine 2014; 5 (4): 190- 5.
16. Saifullah A, Mallhi TH, Khan YH, Iqbal MS, Alotaibi NH, Alzarea AI, et al. Evaluation of risk factors associated with the development of MDR- and XDR-TB in a tertiary care hospital: a retrospective cohort study. PeerJ 2021; 9:e10826
17. Thakurathi B, Giri R, Yadav DK, Khana V, Gurung SC, et al. Multi Drug Resistant Tuberculosis of (15-60 Years) of Far-Western Region of Nepal. Journal of Tuberculosis andTherapeutics 2017; 2: 106.
18. Dalton T, Cegielski P, Akksilp S, Asencios L, Caoili JC, Cho S-N, et al. Prevalence of and risk factors for resistance to second-line drugs in people with multidrug-resistant tuberculosis in eight countries: a prospective cohort study. The Lancet 2012; 380(9851):1406–1417
19. Chuchottaworn C, Thanachartwet V, Sangsayunh P, Than TZ, Sahassananda D, Surabotsophon M, et al Risk factors for multidrug-resistant tuberculosis among patients with pulmonary tuberculosis at the Central Chest Institute of Thailand. PLOS ONE 2015; 10(10):e0139986
20. Demile B, Zenebu A, Shewaye H, Xia S, Guadie A. Risk factors associated with multidrug-resistant tuberculosis (MDR-TB) in a tertiary armed force referral and teaching hospital, Ethiopia. BMC Infectious Diseases 2018; 18(1):249.
21. Gallo JF, Pinhata JMW, Simonsen V, Galesi VMN, Ferrazoli L, et al. Prevalence, associated factors, outcomes and transmission of extensively drug-resistant tuberculosis among multidrug-resistant tuberculosis patients in Sa~o Paulo, Brazil: a cross-sectional study. Clinical Microbiology and Infection 2018; 24:E889e895.
22. Sinha P, Srivastava GN, Gupta A, Anupurba S. Association of risk factors and drug resistance pattern in tuberculosis patients in North India, Journal of GlobalInfectious Diseases 2017;9(4):139-145.
23. Desissa F, Workineh T, Beyene T. Risk factors for the occurrence of multidrug-resistant tuberculosis among patients undergoing multidrug-resistant tuberculosis treatment inEast Shoa, Ethiopia. BMC Public Health 2018; 18:422-28.
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