Acquired resistance to second-line drugs among persons with tuberculosis in the United States

Details

• Alternative Title:
  Clin Infect Dis
• Personal Author:
  Ershova, Julia V. ; Kurbatova, Ekaterina V. ; Moonan, Patrick K. ; Cegielski, J. Peter
• Description:
  Background
  
  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.
  
  Methods
  
  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.
  
  Results
  
  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).
  
  Conclusion
  
  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.
  
  
• Subjects:
  Administration, Intravenous Adolescent Adult Aged Analysis Of Variance Antitubercular Agents Child Child, Preschool Drug Resistance, Multiple, Bacterial Fluoroquinolones Humans Infant Logistic Models Male Middle Aged Prevalence Public Health Surveillance Risk Factors Tuberculosis, Multidrug-Resistant

  More +
• Source:
  Clin Infect Dis. 55(12):1600-1607.
• Pubmed ID:
  22942206
• Pubmed Central ID:
  PMC4758461
• Document Type:
  Journal Article
• Funding:
  CC999999/Intramural CDC HHS/United States
• Place as Subject:
  United States
• Volume:
  55
• Issue:
  12
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:ff57d9f2bec4316ecdcde505a6dc6440579660190c71ad93cf225b5e361e9e39
• Download URL:
  https://stacks.cdc.gov/view/cdc/38089/cdc_38089_DS1.pdf
• File Type:
  [PDF - 550.21 KB ]