Determinants of drug-resistant tuberculosis: analysis of 11 countries

Int J Tuberc Lung Dis. 2001 Oct;5(10):887-93.

Abstract

Setting: Eleven countries/territories.

Objectives: Global information on the determinants of drug-resistant tuberculosis (TB) based on representative data is not available. We therefore studied the relationship between demographic characteristics, prior TB treatment, and human immunodeficiency virus (HIV) infection with anti-tuberculosis drug resistance.

Methods: Population-based representative data on new and previously treated patients with TB collected within an international drug resistance surveillance network.

Results: Of 9,615 patients, 8,222 (85.5%) were new cases of TB and 1,393 (14.5%) were previously treated cases. Compared with new cases, previously treated cases were significantly more likely to have resistance to one (OR = 2.5,95% CI 2.1-3.0; P < 0.001), two (OR = 4.6, 95%CI 3.7-5.6; P < 0.001), three (OR = 11.5, 95%CI 8.6-15.3; P < 0.001), and four (OR = 18.5, 95% CI 12.0-28.5; P < 0.001) drugs. An approximately linear increase in the likelihood of having multidrug-resistant tuberculosis (MDR-TB) was observed as the total time (measured in months) of prior anti-tuberculosis treatment increased (P < 0.001, chi2 for trend). In multivariate analysis, prior TB treatment for 6-11 months (OR = 7.6, 95% CI 2.6, 22.4; P < 0.001) and > or = 12 months (OR 13.7, 95% CI 4.5-41.6; P < 0.001), but not HIV positivity, was associated with MDR-TB.

Conclusion: This study shows that prior but ineffective treatment is a strong predictor of drug resistance, and that HIV is not an independent risk factor for MDR-TB. The association between length of treatment and drug resistance may reflect longer treatment as a result of treatment failure in patients with drug resistance; it may also reflect irregular prior treatment for TB, leading to drug resistance.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Africa / epidemiology
  • Age Factors
  • Americas / epidemiology
  • Antibiotics, Antitubercular / therapeutic use
  • Asia / epidemiology
  • Child
  • Child Welfare
  • Child, Preschool
  • Drug Resistance, Multiple*
  • Ethambutol / therapeutic use
  • Europe / epidemiology
  • Female
  • HIV / drug effects
  • HIV Infections / complications
  • HIV Infections / drug therapy
  • HIV Infections / epidemiology
  • Humans
  • Infant
  • Infant Welfare
  • Infant, Newborn
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Population Surveillance
  • Prevalence
  • Rifampin / therapeutic use
  • Tuberculosis, Multidrug-Resistant / complications
  • Tuberculosis, Multidrug-Resistant / drug therapy
  • Tuberculosis, Multidrug-Resistant / epidemiology*

Substances

  • Antibiotics, Antitubercular
  • Ethambutol
  • Rifampin