Patterns of Multidrug Resistance and Treatment Outcomes Among Pulmonary Tuberculosis Patients in Bangladesh

Abstract

Background: To effectively manage tuberculosis (TB), it is essential to address the high incidence of the disease, as multidrug-resistant pulmonary TB (MDR-PTB) remains a significant concern to halt pre-extensive drug-resistant (pre-XDR) recrudescence. The objective of the current study was to examine and compare MDR-PTB patterns among adult PTB patients (>12 years) in Bangladesh's urban and rural areas who had newly diagnosed and previously treated PTB. Methods: A total of 430 newly diagnosed and previously treated adult patients with PTB were randomly recruited during two study periods: the 1st period, from May 2010 to December 2010 (eight months), and the 2nd period, from January 2014 to January 2015 (thirteen months). Only the drug-resistant (DR) patients were included in the final analysis. Mycobacteriological tests, i.e., smear microscopy, culture, drug susceptibility testing (proportion method of Canetti), line-probe assay, and GeneXpert MTB/RIF were performed. Logistic regression analysis was used to determine the strength of associations between treatment outcomes and predictor variables. Results: Of the newly diagnosed patients, 156 cases were negative and drug-sensitive (DS) at diagnosis, and 274 patients exhibited various DR patterns. During the 1st period, MDR-PTB was 26% among newly diagnosed patients, while the proportion was 31% among previously treated patients in the 2nd period. The majority of MDR-PTB belonged to the age group of ≤45 years. Male patients consistently revealed a higher proportion of MDR-PTB compared to females in both the newly diagnosed and previously treated groups. Conclusion: The proportion of MDR-PTB was higher among the previously treated patients than among newly diagnosed patients. Regardless of demographic characteristics, a significant proportion of patients showed DR, particularly in previously treated groups, indicating a substantial burden of MDR-PTB.

Keywords: Mycobacterium tuberculosis; diagnostics; multidrug-resistant; pulmonary tuberculosis.

Figure 1

A graphical location of National Institute of Diseases of the Chest & Hospital (NIDCH) and National Tuberculosis Programme (NTP), Dhaka, Bangladesh. The distance between NTP and NIDCH (~0.5–1 km) is tiny compared to the national scale.

Figure 2

Flowchart for categorizing participants with their MDR patterns in two different study periods. Note: PTB = Pulmonary TB, LPA = Line Probe Assay, DST = Drug Susceptibility Testing, DR = Drug Resistant, MDR = Multi-Drug Resistant, DS = Drug Sensitive.