Acquired resistance to second-line drugs among persons with tuberculosis in the United States
Published Date:Aug 31 2012
Source:Clin Infect Dis. 55(12):1600-1607.
Analysis Of Variance
Drug Resistance, Multiple, Bacterial
Public Health Surveillance
Pubmed Central ID:PMC4758461
Funding:CC999999/Intramural CDC HHS/United States
Acquired resistance to second-line drugs (SLD) is a problem in treating patients with drug-resistant tuberculosis (TB) worldwide. The objectives of this study were to identify risk factors for acquired resistance (AR) to injectable SLD and fluoroquinolones in the US National TB Surveillance System, 1993–2008.
We selected cases with initial and final drug susceptibility test (DST) results reported. We defined AR as resistance at the final DST but susceptibility to the same drug at the initial DST. We analyzed AR using 2-way frequency tables and multivariable logistic regression.
Baseline prevalence of multidrug-resistant (MDR) and extensively drug-resistant (XDR)TB was 12.6% (1864/14,770) and 0.38% (56/14,770), respectively. Of 2,274 individuals without initial resistance to injectable SLD, 49 (2.2%) acquired resistance. Of 1,141 initially susceptible to fluoroquinolones, 32 (2.8%) acquired resistance. AR to injectable SLD was associated with age group 25–44 years (adjusted Odds Ratio [aOR], 2.7; 95% confidence interval [CI], 1.2–6.3), positive HIV status (aOR, 2.5; 95% CI, 1.3–4.7), MDR at treatment initiation (aOR, 5.5; 95% CI, 2.9–10.5), and treatment with any SLD (aOR, 2.4; 95% CI,1.2–4.7). AR to fluoroquinolones was associated with MDR TB at treatment initiation (aOR, 6.5; 95% CI, 2.9–14.6).
Among patients with initial and final DST reported, risk factors for AR to injectable SLD included age, positive HIV status, MDR TB and initial treatment with any SLD, while the only predictor for AR to fluoroquinolones was MDR TB at treatment initiation. Providers should consider monitoring SLD DST for MDR TB patients in the indicated subgroups.
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