Anti-tuberculosis drug resistance in Bangladesh: reflections from the first nationwide survey

S M M Kamal, A Hossain, S Sultana, V Begum, N Haque, J Ahmed, T M A Rahman, K A Hyder, S Hossain, M Rahman, Chowdhury R Ahsan, R A Chowdhury, K J M Aung, A Islam, R Hasan, A Van Deun

Research output: Contribution to journalA1: Web of Science-article

Abstract

OBJECTIVE: To determine the prevalence of tuberculosis (TB) drug resistance in Bangladesh.

DESIGN: Weighted cluster sampling among smear-positive cases, and standard culture and drug susceptibility testing on solid medium were used.

RESULTS: Of 1480 patients enrolled during 2011, 12 falsified multidrug-resistant TB (MDR-TB) patients were excluded. Analysis included 1340 cases (90.5% of those enrolled) with valid results and known treatment antecedents. Of 1049 new cases, 12.3% (95%CI 9.3-16.1) had strains resistant to any of the first-line drugs tested, and 1.4% (95%CI 0.7-2.5) were MDR-TB. Among the 291 previously treated cases, this was respectively 43.2% (95%CI 37.1-49.5) and 28.5% (95%CI 23.5-34.1). History of previous anti-tuberculosis treatment was the only predictive factor for first-line drug resistance (OR 34.9). Among the MDR-TB patients, 19.2% (95%CI 11.3-30.5; exclusively previously treated) also showed resistance to ofloxacin. Resistance to kanamycin was not detected.

CONCLUSION: Although MDR-TB prevalence was relatively low, transmission of MDR-TB may be increasing in Bangladesh. MDR-TB with fluoroquinolone resistance is rapidly rising. Integrating the private sector should be made high priority given the excessive proportion of MDR-TB retreatment cases in large cities. TB control programmes and donors should avoid applying undue pressure towards meeting global targets, which can lead to corruption of data even in national surveys.

Original languageEnglish
JournalInternational Journal of Tuberculosis and Lung Disease
Volume19
Issue number2
Pages (from-to)151-156
Number of pages6
ISSN1027-3719
DOIs
Publication statusPublished - 2015

Keywords

  • Adolescent
  • Adult
  • Aged
  • Antitubercular Agents
  • Bangladesh
  • Cross-Sectional Studies
  • Drug Resistance, Multiple, Bacterial
  • Female
  • Fluoroquinolones
  • Humans
  • Male
  • Microbial Sensitivity Tests
  • Middle Aged
  • Mycobacterium tuberculosis
  • Prevalence
  • Sputum
  • Tuberculosis, Multidrug-Resistant
  • Young Adult

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