Details:

Alternative Title:
Clin Infect Dis
Personal Author:
Ershova, Julia V. ; Kurbatova, Ekaterina V. ; Moonan, Patrick K. ; Cegielski, J. Peter
Ershova, Julia V. ; Kurbatova, Ekaterina V. ; Moonan, Patrick K. ; Cegielski, J. Peter Less -
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.


Subject:
[+]
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

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
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:ff57d9f2bec4316ecdcde505a6dc6440579660190c71ad93cf225b5e361e9e39
File Type:

Supporting Files

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