Figure 1
Study population.
aAny resistance (resistance to any of the anti-TB drugs) + and mono-resistance (resistance to only one drug) + poly-resistance (resistance to at least two drugs, excluding the isoniazid and rifampin combination).
MDR, multidrug resistant; XDR, extensively drug-resistant; TB, tuberculosis; DST, drug susceptibility testing.
Table 1Demographic data and description of all patients studied
Characteristic |
Data |
Age (y) |
46.5 ± 21.2 |
Susceptible |
46.6 ± 22.0 |
MDR |
46.6 ± 18.8 |
XDR |
54.0 ± 13.1 |
Frequency per age-group (y) |
< 20 |
19 (12.1) |
20–40 |
47 (29.9) |
40–60 |
44 (28.0) |
> 60 |
47 (29.9) |
Range |
88.0 |
Gender |
Male |
66 (42.0) |
Female |
91 (58.0) |
Total |
157 (100.0) |
Table 2Frequency of drug resistance subjects according to positive culture isolates, MDR and XDR cases
Drug resistance pattern |
New case |
Previously treated case |
|
Relapse |
Failure |
Total of isolates |
Susceptible |
102 (65.0) |
8 (5.1) |
11 (7.0) |
121 (77.1) |
MDR |
26 (16.5) |
2 (1.3) |
5 (3.2) |
33 (21.0) |
XDR |
1 (0.7) |
0 (0.0) |
2 (1.2) |
3 (1.9) |
Total |
129 (82.2) |
10 (6.4) |
18 (11.4) |
157 (100.0) |
Table 3Distribution of risk factor rates among positive culture isolates
Description of cases*
|
Data |
HIV infection |
12/71 (16.9) |
Cigarette use |
30/79 (38.0) |
Extra pulmonary involvement |
41/97 (42.3) |
Cavity (chest X-ray) |
25/73 (34.2) |
Received prior treatment |
28/81 (34.6) |
Treatment with fluoroquinolone/injectable second-line drugs |
4.0/47 (8.5) |
High risk jobs |
15/57 (26.3) |
Diabetes |
34/87 (39.1) |
Table 4Frequency of first-line and second-line anti-TB drug resistance profiles among positive culture isolates and MDR-TB cases, respectively, in Tehran, Iran between 2006 and 2013 (n = 1,442)
Any drug resistance |
Frequency (%) |
First-line rates |
EMB |
169 (11.7) |
SM |
330 (22.9) |
RIF |
176 (12.2) |
INH |
168 (11.6) |
MDR-TBa
|
33 (2.3 vs. MTB) |
INH+RIF |
2 (0.1) |
INH+RIF+EMB |
7 (0.5) |
INH+RIF+SM |
9 (0.6) |
INH+RIF+SM+EMB |
15 (1.1) |
XDR-TBb
|
3 (0.2 vs. MTB) |
Susceptible |
316 (21.9) |
Mixed resistancec
|
1,090 (75.6) |
Second-line rates |
OFX |
10 (30.3; vs. MDR) |
PAS |
16 (48.5) |
CPM |
13 (39.4) |
KM |
12 (36.3) |
AMK |
15 (45.4) |
CYC |
15 (45.4) |
ETH |
13 (39.4) |
XDR-TB |
3 (9.0 vs. MDR) |
OFX+PAS+CPM+KM+AMK+ETH |
1 (3.0) |
OFX+CPM+AMK+ETH |
1 (3.0) |
OFX+AMK |
1 (3.0) |
Table 5Risk factors in patients with MDR-TB and XDR-TB (bivariate analysis)
Factor*
|
OR (95% CI) |
MDR-TB |
XDR-TB |
Age (y) |
< 20 |
0.28 (0.27–2.88) |
0.97 (0.35–1.86) |
20–40 |
0.17 (0.07–0.60) |
0.99 (0.31–3.06) |
40–60 |
0.84 (0.19–7.49) |
0.52 (0.19–25.00) |
> 60 |
- |
- |
Male gender |
0.27 (0.18–0.78) |
- |
HIV infection |
0.09 (0.66–17.20) |
0.00 |
Cigarette use |
0.62 (0.10–3.74) |
0.83 (0.72–25.50) |
Extra pulmonary involvement |
0.30 (0.47–10.80) |
0.61 (0.12–31.70) |
Cavity (chest X-ray) |
0.56 (0.004–1.07) |
- |
Received prior treatment |
0.87 (0.17–4.33) |
0.45 (0.11–7.70) |
Treatment with fluoroquinolone/Injectable |
0.74 (0.15–3.18) |
0.16 (0.005–2.40) |
High-risk jobs |
0.13 (0.66–24.10) |
0.68 (0.78–48.80) |
Diabetes |
1.01 (1.09–30.70) |
0.48 (0.13–70.70) |