Format

Send to

Choose Destination
PLoS One. 2015 Jan 21;10(1):e0116798. doi: 10.1371/journal.pone.0116798. eCollection 2015.

Resistance patterns among multidrug-resistant tuberculosis patients in greater metropolitan Mumbai: trends over time.

Author information

1
Jupiter Hospital, Thane, India.
2
Vasant Vihar, Thane, India.
3
Médecins Sans Frontières (MSF) / Doctors Without Borders, Mumbai, India.
4
GTB Hospital, Sewri, Mumbai, India.
5
Lilavati Hospital, Mumbai, India.
6
Fortis Hospital, Mumbai, India.
7
Bhatia Hospital, Mumbai, India.
8
Observer Research Foundation, Mumbai, India.
9
L. H. Hiranandani Hospital, Mumbai, India.
10
Dr. D. Y. Patil Hospital, Navi Mumbai, India.
11
P.D. Hinduja National Hospital and Medical Research Centre, Mumbai, India.

Abstract

BACKGROUND:

While the high burden of multidrug-resistant tuberculosis (MDR-TB) itself is a matter of great concern, the emergence and rise of advanced forms of drug-resistance such as extensively drug-resistant TB (XDR-TB) and extremely drug-resistant TB (XXDR-TB) is more troubling. The aim of this study was to investigate the trends over time of patterns of drug resistance in a sample of MDR-TB patients in greater metropolitan Mumbai, India.

METHODS:

This was a retrospective, observational study of drug susceptibility testing (DST) results among MDR-TB patients from eight health care facilities in greater Mumbai between 2005 and 2013. We classified resistance patterns into four categories: MDR-TB, pre-XDR-TB, XDR-TB and XXDR-TB.

RESULTS:

A total of 340 MDR-TB patients were included in the study. Pre-XDR-TB was the most common form of drug-resistant TB observed overall in this Mumbai population at 56.8% compared to 29.4% for MDR-TB. The proportion of patients with MDR-TB was 39.4% in the period 2005-2007 and 27.8% in 2011-2013, while the proportion of those with XDR-TB and XXDR-TB was changed from 6.1% and 0% respectively to 10.6% and 5.6% during the same time period. During the same periods, the proportions of patients with ofloxacin, moxifloxacin and ethionamide resistance significantly increased from 57.6% to 75.3%, from 60.0% to 69.5% and from 24.2% to 52.5% respectively (p<0.05).

DISCUSSION:

The observed trends in TB drug-resistance patterns in Mumbai highlight the need for individualized drug regimens, designed on the basis of DST results involving first- and second-line anti-TB drugs and treatment history of the patient. A drug-resistant TB case-finding strategy based on molecular techniques that identify only rifampicin resistance will lead to initiation of suboptimal treatment regimens for a significant number of patients, which may in turn contribute to amplification of resistance and transmission of strains with increasingly advanced resistance within the community.

PMID:
25606853
PMCID:
PMC4301863
DOI:
10.1371/journal.pone.0116798
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Public Library of Science Icon for PubMed Central
Loading ...
Support Center