Patterns of TB drug-resistance in a tertiary care facility in Pune, India

Introduction:Globally, the emergence of multi-drug resistant tuberculosis (MDRTB) (defined as resistance to isoniazid (INH) and rifampicin (RIF) and extensively drug resistant (XDR-TB) (defined as resistance to INH, RIF, any fluoroquinolone and to at least one of the three injectable second line drugs-amikacin, kanamycin, capreomycin) has become a major challenge to effective TB control [1-4]. In 2008, of the estimated global annual incidence of 9.4 million TB cases, 1.98 million were estimated to have occurred in India. Among them, 131,000 were MDR-TB cases, representing 25% of the global MDR-TB burden [2,5].

 

Most hospitals including public hospitals in India do not have the necessary facilities to conduct routine testing for MDR- and XDR-TB. Yet these are the very places where many seek care and where there is particular risk for transmission to health care workers and to patients alike. Further, MDR-TB treatment comprisestoxic, expensive secondline drugs that have limited sterilizing capacity [6,7] resulting in poor treatment outcomes. Documenting the burden and antibiotic resistance patterns among patients suspected to have drug resistant TB is critical for patient management and for hospital resource allocation. Thus, the objective of our study was to evaluate the prevalence of MDR-TB and XDR-TB among patients presenting with suspected MDR-TB at our urban government medical college teaching hospital which caters to the city of >4 million people in Pune, India.