Rifampin Resistant Tuberculosis; Factors and Demo- Graphic Features

Authors

  • Huda Sarwar Institute of Public Health, Lahore, Pakistan
  • Muhammad Azam 1Institute of Public Health, Lahore, Pakistan 2Punjab Rangers Teaching Hospital, Lahore, Pakistan 3Children Hospital, Faisalabad, Pakistan 4Gulab Devi Teaching Hospital, Lahore, Pakistan Correspondence: Dr Huda Sarwar, Department of Epidemiology, Institute of Public Health, Lahore, Email: hudasarwar@gmail.com
  • Maaz Suhail Rana Punjab Rangers Teaching Hospital, Lahore, Pakistan
  • Muhammad Umar Farooq Institute of Public Health, Lahore, Pakistan
  • Erum Sarwar Children Hospital, Faisalabad, Pakistan
  • Atiqa Ambreen Gulab Devi Teaching Hospital, Lahore, Pakistan

DOI:

https://doi.org/10.47489/szmc.v38i3.523

Keywords:

Rifampin Resistance, Tuberculosis, DR-TB, Pakistan, High TB burden

Abstract

Introduction: Pakistan has the highest burden of Tuberculosis (TB) worldwide and the 5th highest prevalence of multi- drug resistant (MDR) TB worldwide. There is scarce data on the socioeconomic characteristics and factors associated with the patients presenting with drug resistant-TB in Pakistani context.

Aims & Objectives: To determine the association of different variables with rifampin resistance (RR) in new and previously treated cases of pulmonary (PTB) and extra-pulmonary TB (EPTB)

Place and Duration of Study: It was a cross-sectional study conducted at Gulab Devi Hospital Lahore, a tertiary care trust hospital. Data was collected from Oct 2021 to December 31, 2021.

Material & Method: By applying convenient sampling technique, 202 individuals were interviewed, and data was recorded on a self-constructed questionnaire. Data was analyzed using SPSS version 24.0. Frequency tables were generated for sociodemographic variables as well as the site of TB and Chi square test was applied to find association between categorical variables. P value of <0.05 was considered significant. Patients who were categorized as having RR- TB based on detection of RR on Gene Xpert RIF/MTB assay were included.

Results: In this study the mean age of the patients was 31.46±14.67 years, 77 (38.1%) patients were males, and 125 (61.9%) patients were females. Statistically significant association was found between the site of RR-TB (PTB or EPTB) and history of repeated TB treatment (p = 0.049) as well as sex (p = 0.019). There were also statistically significant differences between new or previously treated RR-TB and patients’ sex (p = 0.019), repeated treatment (p = 0.049) as well as treatment failure (p < 0.001).

Conclusion: More females compared to males suffered from both RR-EPTB and RR-PTB. Also, a higher number of patients with RR-PTB had a history of repeated TB treatments compared to those with RR-EPTB. In addition, significant association was found between sex, treatment failure and repeat anti-tuberculous therapy in previously treated RR-TB patients as compared to new RR-TB cases.

References

Atif M, Mukhtar S, Sarwar S, Naseem M, Malik I, Mushtaq A. Drug resistance patterns, treatment outcomes and factors affecting unfavourable treatment outcomes among extensively drug resistant tuberculosis patients in Pakistan; a multicentre record review. Saudi Pharmaceutical Journal. 2022;30(4):462-9.doi: 10.1016/j.jsps.2022.01.015

National TB Control Program. National Guidelines for the Management of Tuberculosis in Pakistan. http://ntp.gov.pk/ntp-old/uploads/national_guideline_on_tb_case_management_rev_jan_2015.pdf. Revised 2015 [Accessed 15 October 2022]

Obaidullah Qazi, Hazir Rahman, Zarfishan Tahir, Muhammad Qasim, Sajid Khan, Aftab Ahmad Anjum, Tahir Yaqub, Muhammad Tayyab, Nawab Ali, Sehrish Firyal. Mutation pattern in rifampin resistance determining region of rpoB gene in multidrug-resistant Mycobacterium tuberculosis isolates from Pakistan. International Journal of Mycobacteriology. 2014;3(3):173-177. https://doi.org/10.1016/j.ijmyco.2014.06.00.

WHO. Global tuberculosis report 2019. Geneva: World Health Organization; 2019. https://www.who.int/tb/publications/global_report/en/, [accessed 22 June 2020]

Prasad R, Gupta N, Banka A. Multidrug-resistant tuberculosis/rifampin-resistant tuberculosis: Principles of management. Lung India. 2018 Jan-Feb;35(1):78-81. doi: 10.4103/lungindia.lungindia_98_17.

Philly O’Riordan, Uli Schwab, Logan Sarah, Cooke Graham, Wilkinson Robert J., Davidson Robert N., et al. Rapid molecular detection of rifampin resistance facilitates early diagnosis and treatment of multi-drug resistant tuberculosis. PLoS One. 2008;3:1–7. doi: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0003173

Jang JG, Chung JH. Diagnosis and treatment of multidrug-resistant tuberculosis. Yeungnam University Journal of Medicine. 2020;37(4):277-85.

Khan FU, Rehman AU, Khan FU, Hayat K, Khan A, Ahmad N, Chang J, Malik UR, Fang Y. Assessment of Factors Associated with Unfavorable Outcomes among Drug-Resistant TB Patients: A 6-Year Retrospective Study from Pakistan. International Journal of Environmental Research and Public Health. 2022;19(3):1574. https://doi.org/10.3390/ijerph19031574

Khan AS, Phelan JE, Khan MT, et al. Characterization of rifampin-resistant Mycobacterium tuberculosis in Khyber Pakhtunkhwa, Pakistan. Sci Rep. 2021. 11:14194. https://doi.org/10.1038/s41598-021-93501-4

WHO. World Health Organisation Global Tuberculosis Report 2018. 2018. https://www.who.int/publications/i/item/9789240037021. [Accessed 20 November 2022]

Sultana ZZ, Hoque FU, Beyene J, et al. HIV infection and multidrug resistant tuberculosis: a systematic review and meta-analysis. BMC Infect Dis 21, 51 (2021). https://doi.org/10.1186/s12879-020-05749-2

Chen J, Chen L, Zhou M, et al. Transmission of multidrug-resistant tuberculosis within family households by DTM-PCR and MIRU-VNTR genotyping. BMC Infect Dis 22, 192 (2022). https://doi.org/10.1186/s12879-022-07188-7

Javaid A. Multidrug-resistant tuberculosis: current situation in Pakistan. Pakistan Journal of Chest Medicine. 2017;23(2):28-30.

Channa AA, Jameel N, Khalil R. Prevalence of human immunodeficiency virus infection among the diagnosed tuberculosis patients in Karachi, Pakistan. Int J Res Med Sci. 2016;4(3):789.

van den Hof S, Tursynbayeva A, Abildaev T, Adenov M, Pak S, Ismailov S. HIV and multidrug-resistant tuberculosis: overlapping risk factors. European Respiratory Journal Feb 2015, 45(2):567-569; DOI: 10.1183/09031936.00131014

Singh S, Ambrosio M, Semini I, Tawil O, Saleem M, Imran M, et al. Revitalizing the HIV response in Pakistan: A systematic review and policy implications. International Journal of Drug Policy. 2014;25(1):26-33.

Odone A, Calderon R, Becerra MC, Zhang Z, Contreras CC, Yataco R, et al. Acquired and transmitted multidrug resistant tuberculosis: the role of social determinants. PLoS One. 2016;11(1).

Mulisa G, Workneh T, Hordofa N, Suaudi M, Abebe G. Multidrug-resistant Mycobacterium tuberculosis and associated risk factors in Oromia region of Ethiopia. Int J Infect Dis. 2015;39:57–61.

Masenga SK, Mubila H, Hamooya BM. Rifampin resistance in Mycobacterium tuberculosis patients using GeneXpert at Livingstone Central Hospital for the year 2015: a cross-sectional explorative study. BMC Infect Dis. 2017;17:640. https://doi.org/10.1186/s12879-017-2750-9

Li D, He W, Chen B, Lv P. Primary multidrug-resistant tuberculosis versus drug-sensitive tuberculosis in non-HIV-infected patients: Comparisons of CT findings. PLoS One. 2017;12(6).

Ullah I, Javaid A, Tahir Z, Ullah O, Shah AA, Hasan F, et al. Pattern of Drug Resistance and Risk Factors Associated with Development of Drug Resistant Mycobacterium tuberculosis in Pakistan. PLoS ONE. 2016;11(1). https://doi.org/10.1371/journal.pone.0147529

Bhering M, Kritski A. Primary and acquired multidrug-resistant tuberculosis: Predictive factors for unfavorable treatment outcomes in Rio de Janeiro, 2000-2016. Rev Panam Salud Publica. 2020 Dec 30;44. doi: 10.26633/RPSP.2020.178. PMID: 33417644; PMCID: PMC7778465.

Song Wm, Li Yf, Ma Xb, et al. Primary drug resistance of Mycobacterium tuberculosis in Shandong, China, 2004–2018. Respir Res. 2019;20:223. https://doi.org/10.1186/s12931-019-1199-3

Elbrolosy AM, El Helbawy RH, Mansour OM, et al. Diagnostic utility of GeneXpert MTB/RIF assay versus conventional methods for diagnosis of pulmonary and extra-pulmonary tuberculosis. BMC Microbiol. 2021;21:144. https://doi.org/10.1186/s12866-021-02210-5

Predictors of poor treatment outcome in multi- and extensively drug-resistant pulmonary TB. K. Kliiman, A. Altraja. European Respiratory Journal. 2009;33:1085-1094; DOI: 10.1183/09031936.00155708

Desai U, Joshi JM. Extrapulmonary drug-resistant tuberculosis at a drug-resistant tuberculosis center, Mumbai: Our experience - Hope in the midst of despair! Lung India. 2019;36(1):3-7. doi: 10.4103/lungindia.lungindia_192_18. PMID: 30604698; PMCID: PMC6330803

Loutet MG, Davidson JA, Brown T, Dedicoat M, Thomas HL, Lalor MK. Acquired resistance to antituberculosis drugs in England, Wales, and Northern Ireland, 2000–2015. Emerging Infectious Diseases. 2018;24(3):524.

Ma J, Liu H, Wang J, Li W, Fan L, Sun W. HIV-Negative Rifampin Resistance/Multidrug-Resistant Extrapulmonary Tuberculosis in China from 2015 to 2019: A Clinical Retrospective Investigation Study from a National Tuberculosis Clinical Research Center. Infect Drug Resist. 2022;15:1155-1165. doi: 10.2147/IDR.S342744

Downloads

Published

2024-09-30

How to Cite

1.
Sarwar H, Azam M, Rana MS, Farooq MU, Sarwar E, Ambreen A. Rifampin Resistant Tuberculosis; Factors and Demo- Graphic Features. Proceedings S.Z.M.C [Internet]. 2024 Sep. 30 [cited 2024 Nov. 21];38(3):226-32. Available from: https://proceedings-szmc.org.pk/index.php/szmc/article/view/523