Incidence and risk factors for extensively drug-resistant tuberculosis in Delhi region.

BACKGROUND: India with a major burden of multidrug-resistant tuberculosis (MDR-TB) does not have national level data on this hazardous disease. Since 2006, emergence of extensively drug-resistant TB (XDR-TB) is considered a serious threat to global TB control. This study highlights the demographic and clinical risk factors associated with XDR-TB in Delhi. METHODS: The study was conducted during April 2007 to May 2010. Six hundred eleven MDR-TB suspects were enrolled from four tertiary care hospitals, treating TB patients in Delhi and the demographic details recorded. Sputum samples were cultured using rapid, automated liquid culture system (MGIT 960). Drug susceptibility testing (DST) for Rifampicin (RIF) and Isoniazid (INH) was performed for all positive M. tuberculosis (M.tb) cultures. All MDR-TB isolates were tested for sensitivity to second-line drugs [Amikacin (AMK), Capreomycin (CAP), Ofloxacin (OFX), Ethionamide (ETA)]. RESULTS/FINDINGS: Of 611, 483 patients were infected with MDR M. tuberculosis (M.tb) strains. Eighteen MDR-TB isolates (3.7%) were XDR M.tb strains. Family history of TB (p 0.045), socioeconomic status (p 0.013), concomitant illness (p 0.001) and previous intake of 2(nd) line injectable drugs (p 0.001) were significantly associated with occurrence of XDR-TB. Only two of the patients enrolled were HIV seropositive, but had a negative culture for M. tuberculosis. 56/483 isolates were pre-XDR M. tuberculosis, though the occurrence of pre-XDR-TB did not show any significant demographical associations. CONCLUSIONS: The actual incidence and prevalence rate of XDR-TB in India is not available, although some scattered data is available. This study raises a concern about existence of XDR-TB in India, though small, signaling a need to strengthen the TB control program for early diagnosis of both tuberculosis and drug resistance in order to break the chains of transmission

Diagram shows the distribution of multidrug-resistant/pre-extensively drug-resistant and extensively drug-resistant <i>M. tuberculosis</i> isolates with additional resistance profile.

<p>Diagram shows the distribution of multidrug-resistant/pre-extensively drug-resistant and extensively drug-resistant <i>M. tuberculosis</i> isolates with additional resistance profile.</p

Comparison of clinical characteristics (categorical values) of MDR, p-XDR and XDR-TB isolates.

<p>P values were calculated using chi-square test, values <0.05 considerd as significant.</p><p>CXR = Chest X-Ray, MDR-TB = Multi Drug Resistant Tuberculosis, p-XDR-TB = Pre Extensively Drug Resistant Tuberculosis, XDR-TB = Extensively Drug Resistant Tuberculosis, FQS = Fluroquinolones, BCG =  Bacillus Calmette–Guérin.</p><p><b>Boldface</b> indicates statistically significant differences.</p

P value comparison of patients with history of previous intake of 2^nd line injectable drugs among MDR, p-XDR and XDR-TB isolates.

<p>P values were calculated using Fisher's exact test, values <0.05 considerd as significant.</p><p>MDR-TB = Multi Drug Resistant Tuberculosis, p-XDR-TB = Pre Extensively Drug Resistant Tuberculosis, XDR-TB = Extensively Drug Resistant Tuberculosis.</p><p><b>Boldface</b> indicates statistically significant differences.</p