Development of Multidrug Resistant Tuberculosis in Bangladesh: A Case-Control Study on Risk Factors

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Abstract

Objective

To determine the risk factors for developing multidrug resistant tuberculosis in Bangladesh.

Methods

This case-control study was set in central, district and sub-district level hospitals of rural and urban Bangladesh. Included were 250 multidrug resistant tuberculosis (MDR-TB) patients as cases and 750 drug susceptible tuberculosis patients as controls. We recruited cases from all three government hospitals treating MDR-TB in Bangladesh during the study period. Controls were selected randomly from those local treatment units that had referred the cases. Information was collected through face-to-face interviews and record reviews. Unadjusted and multivariable logistic regression were used to analyse the data.

Results

Previous treatment history was shown to be the major contributing factor to MDR-TB in univariate analysis. After adjusting for other factors in multivariable analysis, age group “18–25” (OR 1.77, CI 1.07–2.93) and “26–45” (OR 1.72, CI 1.12–2.66), some level of education (OR 1.94, CI 1.32–2.85), service and business as occupation (OR 2.88, CI 1.29–6.44; OR 3.71, CI 1.59–8.66, respectively), smoking history (OR 1.58, CI 0.99–2.5), and type 2 diabetes (OR 2.56 CI 1.51–4.34) were associated with MDR-TB. Previous treatment was not included in the multivariable analysis as it was correlated with multiple predictors.

Conclusion

Previous tuberculosis treatment was found to be the major risk factor for MDR-TB. This study also identified age 18 to 45 years, some education up to secondary level, service and business as occupation, past smoking status, and type 2 diabetes as comorbid illness as risk factors. National Tuberculosis programme should address these risk factors in MDR-TB control strategy. The integration of MDR-TB control activities with diabetes and tobacco control programmes is needed in Bangladesh.

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Most cited references 22

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Risk factors for multidrug resistant tuberculosis in Europe: a systematic review.

A Faustini, A J Hall, C A Perucci (2006)

The resurgence of tuberculosis (TB) in western countries has been attributed to the HIV epidemic, immigration, and drug resistance. Multidrug resistant tuberculosis (MDR-TB) is caused by the transmission of multidrug resistant Mycobacterium tuberculosis strains in new cases, or by the selection of single drug resistant strains induced by previous treatment. The aim of this report is to determine risk factors for MDR-TB in Europe. A systematic review was conducted of published reports of risk factors associated with MDR-TB in Europe. Meta-analysis, meta-regression, and sub-grouping were used to pool risk estimates of MDR-TB and to analyse associations with age, sex, immigrant status, HIV status, occurrence year, study design, and area of Europe. Twenty nine papers were eligible for the review from 123 identified in the search. The pooled risk of MDR-TB was 10.23 times higher in previously treated than in never treated cases, with wide heterogeneity between studies. Study design and geographical area were associated with MDR-TB risk estimates in previously treated patients; the risk estimates were higher in cohort studies carried out in western Europe (RR 12.63; 95% CI 8.20 to 19.45) than in eastern Europe (RR 8.53; 95% CI 6.57 to 11.06). National estimates were possible for six countries. MDR-TB cases were more likely to be foreign born (odds ratio (OR) 2.46; 95% CI 1.86 to 3.24), younger than 65 years (OR 2.53; 95% CI 1.74 to 4.83), male (OR 1.38; 95% CI 1.16 to 1.65), and HIV positive (OR 3.52; 95% CI 2.48 to 5.01). Previous treatment was the strongest determinant of MDR-TB in Europe. Detailed study of the reasons for inadequate treatment could improve control strategies. The risk of MDR-TB in foreign born people needs to be re-evaluated, taking into account any previous treatment.

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Multidrug-resistant tuberculosis: epidemiology, risk factors and case finding.

M Caminero (2010)

Although the multidrug-resistant tuberculosis (MDR-TB) epidemic is a very recent problem, many studies have attempted to understand it. We now have good estimates of the current burden (approximately 500 000 MDR-TB cases worldwide), and following the introduction of potential MDR-TB control strategies projections of these figures are being estimated. The projected trends in tuberculosis (TB) and MDR-TB incidence vary. Risk factors for resistance can be divided into two categories: 1) those facilitating the selection of resistance in the community and 2) the specific conditions that appear to increase some patients' vulnerability to resistance. The epidemiological situation varies greatly across countries, principally due to poor treatment practices and poor implementation of control programmes in the past-and even today, to a lesser degree-and recent data have suggested that national TB programmes that use existing drugs efficiently can postpone and even reverse the MDR-TB epidemic. Other factors that have also contributed to this epidemic situation are analysed in this article. The recognition of factors leading to the epidemic in some regions and the identification of populations at risk will assist in focusing case-finding efforts. From an individual perspective, treatment failures with first-line rifampicin-containing regimens and contacts of MDR-TB cases have the highest rates of resistance. Patients previously treated for TB and the other risk factors analysed in this article should be prioritised in case finding.

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Is HIV Infection a Risk Factor for Multi-Drug Resistant Tuberculosis? A Systematic Review

Sujit Suchindran, Emily S Brouwer, Annelies van Rie (2009)

Background Tuberculosis (TB) is an important cause of human suffering and death. Human immunodeficiency virus (HIV), multi-drug resistant TB (MDR-TB), and extensive drug resistant tuberculosis (XDR-TB) have emerged as threats to TB control. The association between MDR-TB and HIV infection has not yet been fully investigated. We conducted a systematic review and meta-analysis to summarize the evidence on the association between HIV infection and MDR-TB. Methods and Results Original studies providing Mycobacterium tuberculosis resistance data stratified by HIV status were identified using MEDLINE and ISI Web of Science. Crude MDR-TB prevalence ratios were calculated and analyzed by type of TB (primary or acquired), region and study period. Heterogeneity across studies was assessed, and pooled prevalence ratios were generated if appropriate. No clear association was found between MDR-TB and HIV infection across time and geographic locations. MDR-TB prevalence ratios in the 32 eligible studies, comparing MDR-TB prevalence by HIV status, ranged from 0.21 to 41.45. Assessment by geographical region or study period did not reveal noticeable patterns. The summary prevalence ratios for acquired and primary MDR-TB were 1.17 (95% CI 0.86, 1.6) and 2.72 (95% CI 2.03, 3.66), respectively. Studies eligible for review were few considering the size of the epidemics. Most studies were not adjusted for confounders and the heterogeneity across studies precluded the calculation of a meaningful overall summary measure. Conclusions We could not demonstrate an overall association between MDR-TB and HIV or acquired MDR-TB and HIV, but our results suggest that HIV infection is associated with primary MDR-TB. Future well-designed studies and surveillance in all regions of the world are needed to better clarify the relationship between HIV infection and MDR-TB.

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Author and article information

Contributors

Ulrike Gertrud Munderloh: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, USA )

ISSN (Electronic): 1932-6203

Publication date Collection: 2014

Publication date (Electronic): 19 August 2014

Volume: 9

Issue: 8

Electronic Location Identifier: e105214

Affiliations

[1 ]The University of Newcastle, Newcastle, New South Wales, Australia

[2 ]BRAC, Dhaka, Bangladesh

[3 ]National Tuberculosis Control Programme, Directorate General of Health Services, Dhaka, Bangladesh

[4 ]National Institute of Diseases of the Chest and Hospital, Dhaka, Bangladesh

University of Minnesota, United States of America

Author notes

* E-mail: mahfuza.rifat@ 123456uon.edu.au

Competing Interests: The authors have declared that no competing interests exist.

Conceived and designed the experiments: MR AHM JH. Performed the experiments: MR BNS MAI. Analyzed the data: MR CO. Contributed reagents/materials/analysis tools: MR AHM JH AH MWA. Contributed to the writing of the manuscript: MR AHM JH CO MAI AH MWA BNS.

Article

Publisher ID: PONE-D-14-15070

DOI: 10.1371/journal.pone.0105214

PMC ID: 4138182

PubMed ID: 25136966

SO-VID: ce670315-e357-4654-9d17-bb576f956ede

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 6 May 2014

Date accepted : 17 July 2014

Page count

Pages: 7

Funding

This research was supported by the Australian Respiratory Council, the University of Newcastle, Australia, and BRAC Bangladesh. The funders had no role in study design, data collection and analysis or decision to publish or preparation of manuscript.

Custom metadata

Data Availability The authors confirm that, for approved reasons, some access restrictions apply to the data underlying the findings. All relevant data in this study are freely available in the manuscript as submitted and are included in summary tables and the results section of the manuscript. The author has full access to the dataset. It will be provided upon request to anyone who is interested in the research topic. Interested readers may contact the corresponding author. The electronic version of the dataset is kept with University of Newcastle Australia, following the original research protocol, which has also been approved by Human Research Ethics Committee (HREC) of the University of Newcastle.

Development of Multidrug Resistant Tuberculosis in Bangladesh: A Case-Control Study on Risk Factors

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Abstract

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Most cited references 22

Risk factors for multidrug resistant tuberculosis in Europe: a systematic review.

Multidrug-resistant tuberculosis: epidemiology, risk factors and case finding.

Is HIV Infection a Risk Factor for Multi-Drug Resistant Tuberculosis? A Systematic Review

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