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, 149 (1), 62-66

High Degree of Fluoroquinolone Resistance Among Pulmonary Tuberculosis Patients in New Delhi, India

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High Degree of Fluoroquinolone Resistance Among Pulmonary Tuberculosis Patients in New Delhi, India

Rohini Sharma et al. Indian J Med Res.

Abstract

Background & objectives: : The fluoroquinolones (FQs) group of antibiotics is the backbone drugs for the management of drug-resistant tuberculosis (TB). In routine clinical practice, drug susceptibility testing (DST) for FQs is not performed, and the patients are empirically treated. A limited information exists regarding FQs resistance among pulmonary TB cases. The present study was conducted to determine the FQs resistance among drug sensitive and drug-resistant pulmonary TB patients in a tertiary care centre in north India.

Methods: : A total of 1619 sputum/smear-positive specimens of pulmonary TB patients were subjected to DST for first-line drugs (FLDs) and second-line drugs. In addition, FQs DST was also performed using automated Mycobacterial Growth Indicator Tube-960 liquid culture technique. The immuno-chromatographic assay was performed to distinguish Mycobacterium tuberculosis complex (MTBC) from non-MTBC.

Results: : Mycobacterium tuberculosis (Mtb) was isolated in 1499 sputum specimens; 1099 culture specimens were sensitive to FLDs, 249 grew as multidrug-resistant (MDR) Mtb and the remaining 151 isolates revealed any drug resistance to FLDs. While FQs monoresistance among the FLD sensitive isolates was 3.1 per cent (35/1099), 27.3 per cent (68/249) among MDR Mtb isolates had additional FQs resistance.

Interpretation & conclusions: : FQs resistance among drug sensitive and MDR Mtb isolates was high in Delhi, India. Based on these findings, it is recommended that the DST for FQs should be routinely performed to avoid further amplification of drug resistance.

Keywords: Drug susceptibility testing; extensively drug-resistant tuberculosis; multidrug-resistant tuberculosis; pre-extensively drug-resistant tuberculosis.

Conflict of interest statement

None

Figures

Figure
Figure
Schematic flow of study design. IRL, intermediate reference laboratory Accredited laboratory by Ministry of Health & Family Welfare, Government of India and Revised National Tuberculosis Control Programme, India; AIIMS, All India Institute of Medical Sciences, New Delhi; AFB, acid-fast bacilli; MGIT-960, mycobacterial growth indicator tube; ICA, immunochromatographic assay; FQs, fluoroquinolones; KM, kanamycin; DST, drug susceptibility testing; SLDs, second-line drugs; Mtb, Mycobacterium tuberculosis; TB, Tuberculosis; MDR-TB, multidrug-resistant tuberculosis; XDR-TB, extensively drug-resistant TB; Pre-XDR-TB Mtb isolates resistant to first-line drugs (FLDs) and resistant to second-line injectables or any one of the fluoroquinolones.

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