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Acquired Drug Resistance in Mycobacterium tuberculosis and Poor Outcomes among Patients with Multidrug-Resistant Tuberculosis |
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| Authors: | Russell R. Kempker Maia Kipiani Veriko Mirtskhulava Nestani Tukvadze Matthew J. Magee Henry M. Blumberg |
| Affiliation: | Emory University School of Medicine, Atlanta, Georgia, USA (R.R. Kempker, H.M. Blumberg); ;National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia (M. Kipiani, N. Tukvadze); ;Davit Tvildiani Medical University, Tbilisi (V. Mirtskhulava); ;Georgia State University School of Public Health, Atlanta (M.J. Magee) |
| Abstract: | Rates and risk factors for acquired drug resistance and association with outcomes among patients with multidrug-resistant tuberculosis (MDR TB) are not well defined. In an MDR TB cohort from the country of Georgia, drug susceptibility testing for second-line drugs (SLDs) was performed at baseline and every third month. Acquired resistance was defined as any SLD whose status changed from susceptible at baseline to resistant at follow-up. Among 141 patients, acquired resistance in Mycobacterium tuberculosis was observed in 19 (14%); prevalence was 9.1% for ofloxacin and 9.8% for capreomycin or kanamycin. Baseline cavitary disease and resistance to >6 drugs were associated with acquired resistance. Patients with M. tuberculosis that had acquired resistance were at significantly increased risk for poor treatment outcome compared with patients without these isolates (89% vs. 36%; p<0.01). Acquired resistance occurs commonly among patients with MDR TB and impedes successful treatment outcomes. |
| Keywords: | tuberculosis and other mycobacteria Mycobacterium tuberculosis bacteria multidrug-resistant tuberculosis MDR TB extensively drug-resistant tuberculosis XDR TB antimicrobial resistance multidrug resistance acquired drug resistance treatment outcomes |