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. 2024 Oct 10:13:100471.
doi: 10.1016/j.ijregi.2024.100471. eCollection 2024 Dec.

High incidence of multidrug-resistant tuberculosis in Bhutan: A cohort study based on national TB surveillance data

Thinley Dorji  1   2 , Karchung Tshering  3 , Lila Adhikari  3 , Thinley Jamtsho  4 , Pavitra Bhujel  3 , Pema Lhaden  3 , Norelle L Sherry  2   5   6 , Chantel Lin  2   7 , Kristy Horan  2   5 , Sonam Wangchuk  4 , Patiyan Andersson  2   5   7 , Benjamin P Howden  2   5   6   7
Affiliations

High incidence of multidrug-resistant tuberculosis in Bhutan: A cohort study based on national TB surveillance data

Thinley Dorji et al. IJID Reg. .

Abstract

Objectives: The emergence of multidrug-resistant tuberculosis (MDR-TB) has made the elimination of TB difficult. Currently, there are limited data on MDR-TB and other drug-resistant TB in Bhutan. We aimed to estimate the incidence and explore the potential risk factors associated with MDR/pre-extensively drug-resistant (pre-XDR)-TB using comprehensive national TB data.

Methods: We used the data from the Tuberculosis Information Surveillance System of the National Tuberculosis Reference Laboratory to analyze the resistance pattern and epidemiologic data for all TB cases tested for resistance for the year 2018-2021. Multiple logistic regression was performed to identify risk factors associated with MDR/pre-XDR-TB.

Results: Of the 2,290 samples tested for drug resistance, 10.6% (n = 243) was MDR-TB, 3.5% (n = 81) was isoniazid-resistant TB, and 0.61% (n = 14) was pre-XDR-TB. A high incidence of MDR/RR-TB/pre-XDR-TB was documented among patients in Thimphu, Samtse, and Sarpang districts. MDR/pre-XDR-TB was more likely documented among patients aged 18-39 years (adjusted odds ratio [aOR] 2.79; 95% confidence interval [CI] 1.46-6.07), female sex (aOR 1.37; 95% CI 1.01-1.86), and patients previously treated for TB (aOR 2.98; 95% CI 1.99-4.42).

Conclusions: Given the high burden of MDR-TB in some districts, decentralization of diagnostic facilities for more rapid characterization could improve early recognition of drug-resistant cases and assist in management. Comprehensive follow-up and monitoring of high-risk groups should be performed.

Keywords: Bhutan; High TB burden; MDR-TB; Mycobacterium tuberculosis; Risk factors; TB.

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Conflict of interest statement

The authors have no competing interests to declare.

Figures

Figure 1
Figure 1
Flowchart of the TB samples tested with different tests during the study period. DST: drug susceptibility testing; EPCD: extra-pulmonary clinically diagnosed; EPBC: extrapulmonary bacteriologically confirmed; MDR-TB: multidrug-resistant TB; MTB: Mycobacterium tuberculosis; NTRL: National Tuberculosis Reference Laboratory; PBC: pulmonary bacteriologically confirmed; PCD: pulmonary clinically diagnosed; TB: tuberculosis.
Figure 2
Figure 2
Temporal analysis of different drug resistance profiles from 2018 to 2021. EMB: ethambutol resistant TB; HR-TB: isoniazid-resistant TB; MDR-TB: multidrug-resistant TB; MDR/RR-TB: rifampicin-resistant by Xpert MTB/RIF, isoniazid resistance not confirmed by other test and treated as MDR-TB; pDST: phenotypic drug susceptibility test; pre-XDR TB: pre-extensively drug-resistant TB; RR-TB: rifampicin-resistant TB; STM: streptomycin-resistant TB; TB: tuberculosis. The table below the bar graph shows the number of TB cases for a particular year based on pDST.
Figure 3
Figure 3
Map of Bhutan showing the average distribution of MDR/RR-TB/pre-XDR TB by districts for the year 2018-2021. Symbols indicate the current MDR-TB treatment centers and Gene Xpert MTB/RIF sites. MDR-TB: multidrug-resistant TB; pre-XDR TB: pre-extensively drug-resistant TB; RR-TB: rifampicin resistant TB; TB: tuberculosis.
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References

    1. World Health Organization. Global tuberculosis report 2022, https://www.who.int/teams/global-tuberculosis-programme/tb-reports/globa...; 2022 [accessed 29 July 2024].
    1. Gygli SM, Borrell S, Trauner A, Gagneux S. Antimicrobial resistance in Mycobacterium tuberculosis: mechanistic and evolutionary perspectives. FEMS Microbiol Rev. 2017;41:354–373. doi: 10.1093/femsre/fux011. - DOI - PubMed
    1. World Health Organization. Global tuberculosis report 2023, https://www.who.int/teams/global-tuberculosis-programme/data; 2023 [accessed 30 July 2024].
    1. Lomtadze N, Aspindzelashvili R, Janjgava M, Mirtskhulava V, Wright A, Blumberg HM, et al. Prevalence and risk factors for multidrug-resistant tuberculosis in the Republic of Georgia: a population-based study. Int J Tuberc Lung Dis. 2009;13:68–73. - PMC - PubMed
    1. Chung-Delgado K, Guillen-Bravo S, Revilla-Montag A, Bernabe-Ortiz A. Mortality among MDR-TB cases: comparison with drug-susceptible tuberculosis and associated factors. PLoS One. 2015;10 doi: 10.1371/journal.pone.0119332. - DOI - PMC - PubMed

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