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Development of multidrug resistant tuberculosis in Bangladesh: a case-control study on risk factors.

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.

SUBMITTER: Rifat M

PROVIDER: S-EPMC4138182 | biostudies-other | 2014

REPOSITORIES: biostudies-other

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Project description:BACKGROUND:Tuberculosis remains a major public-health problem in the world, despite several efforts to improve case identification and treatment compliance. It is well known cause of ill-health among millions of people each year and ranks as the second leading cause of death from infectious disease worldwide. Despite implementation of the World health organization recommended strategy, the reductions in the incidence of TB have been minimal in high burden countries. OBJECTIVES AND METHODS:A case control study was carried out to assess the risk factors of TB, where cases were newly registered bacteriologically confirmed pulmonary TB patients with age greater than 15 years who present at twenty health centres in Addis Ababa. Controls were age and sex matched attendees who presented in the same health centers for non-TB health problems. RESULTS:A total of 260 cases and 260 controls were enrolled in the study and 45.8% of cases and 46.2% of controls were in the 26-45 years age bracket. According to the multivariable logistic regression analysis, seven variables were found to be independent predictors for the occurrence of TB after controlling possible confounders. Patients who live in house with no window or one window were almost two times more likely to develop tuberculosis compared to people whose house has multiple windows (AOR = 1.81; 95% CI:1.06, 3.07). Previous history of hospital admission was found to pose risk almost more than three times (AOR = 3.39; 95% CI: 1.64-7.03). Having a household member who had TB was shown to increase risk of developing TB by three fold (AOR = 3.00; 95% CI: 1.60, 5.62). The study showed that illiterate TB patients were found to be more than twice more likely to develop TB compared to subjects who can atleast read and write (AOR, 95% CI = 2.15, 1.05, 4.40). Patients with household income of less than 1000 birrs per month were more than two times more likely to develop TB compared to those who had higher income (AOR = 2.2; 95% CI: 1.28, 3.78). Smoking has also been identified as important risk factor for developing TB by four times (AOR = 4.43; 95% CI: 2.10, 9.3). BCG was found to be protective against TB reducing the risk by one-third (AOR = 0.34; 95% CI: 0.22, 0.54). CONCLUSION:This study showed that TB is more common among the most agile and economically active age group, and number of windows, history of hospital admission, a household member who had TB, illiteracy, low household income and smoking and lack of BCG scar were identified as independent risk factors. Therefore it is imperative that the TB control effort need a strategy to address socio economic issues such as poverty, overcrowding, smoking, and infection control at health care facilities level is an important intervention to prevent transmission of TB within the facilities.

Project description:IntroductionVitamin D status may be an important determinant of multidrug-resistant tuberculosis (MDR-TB) infection, progression to disease and treatment outcomes. Novel and potentially cost-effective therapies such as vitamin D supplementation are needed to stem the tide of TB and MDR-TB globally, particularly in India, a country that accounts for the largest fraction of the world's TB incidence and MDR-TB incidence, and where vitamin D deficiency is endemic. While vitamin D has shown some promise in the treatment of MDR-TB, its role in the context of MDR-TB infection and progression to disease is largely unknown.Methods and analysisThrough a case-control study in Mumbai, India, we aim to examine associations between vitamin D status and active MDR-TB and to investigate vitamin D status and TB infection among controls. Cases are adult outpatient pulmonary patients with MDR-TB recruited from two public TB clinics. Controls are recruited from the cases' household contacts and from non-respiratory departments of the facilities where cases were recruited. Cases and controls are assessed for serum 25-hydroxyvitamin D concentration, nutrient intake, diet quality, anthropometry and other relevant clinical and sociodemographic parameters. Controls undergo additional clinical assessments to rule out active TB and laboratory assessments to determine presence of TB infection. Statistical analysis investigates associations between vitamin D status and active MDR-TB and between vitamin D status and TB infection among controls, accounting for potential confounding effects of diet, anthropometry and other covariates.Ethics and disseminationThis study has been approved by Harvard T.H. Chan School of Public Health Institutional Review Board; Foundation for Medical Research Institutional Research Ethics Committee and Health Ministry's Screening Committee of the Indian Council for Medical Research. Permission was granted by the Municipal Corporation of Greater Mumbai, India, a collaborating partner on this research. Outcomes will be disseminated through publication and scientific presentation.Trial registration numberNCT04342598.

Project description:BACKGROUND: Increasing prevalence of ertapenem-resistant, carbapenem-susceptible Enterobacteriaceae (ERE) in Singapore presents a major therapeutic problem. Our objective was to determine risk factors associated with the acquisition of ERE in hospitalized patients; to assess associated patient outcomes; and to describe the molecular characteristics of ERE. METHODS: A retrospective case-case-control study was conducted in 2009 at a tertiary care hospital. Hospitalized patients with ERE and those with ertapenem-sensitive Enterobacteriaceae (ESE) were compared with a common control group consisting of patients with no prior gram-negative infections. Risk factors analyzed included demographics; co-morbidities; instrumentation and antibiotic exposures. Two parallel multivariate logistic regression models were performed to identify independent variables associated with ERE and ESE acquisition respectively. Clinical outcomes were compared between ERE and ESE patients. RESULTS: Twenty-nine ERE cases, 29 ESE cases and 87 controls were analyzed. Multivariate logistic regression showed that previous hospitalization (Odds ratio [OR], 10.40; 95% confidence interval [CI], 2.19-49.20) and duration of fluoroquinolones exposure (OR, 1.18 per day increase; 95% CI, 1.05-1.34) were unique independent predictors for acquiring ERE. Duration of 4(th)-generation cephalosporin exposure was found to predict for ESE acquisition (OR, 1.63 per day increase; 95% CI, 1.05-2.54). In-hospital mortality rates and clinical response rates were significantly different between ERE and ESE groups, however ERE infection was not a predictor of mortality. ERE isolates were clonally distinct. Ertapenem resistance was likely to be mediated by the presence of extended-spectrum β-lactamases or plasmid-borne AmpC in combination with impermeability due to porin loss and/or efflux pumps. CONCLUSION: Prior hospitalization and duration of fluoroquinolone treatment were predictors of ERE acquisition. ERE infections were associated with higher mortality rates and poorer clinical response rates when compared to ESE infections.

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Development of multidrug resistant tuberculosis in Bangladesh: a case-control study on risk factors.

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