Predictors of Extensively Drug-Resistant Pulmonary Tuberculosis
Abstract
Background: About 40 000 cases of extensively drug-resistant tuberculosis emerge worldwide annually, but the predictors of extensive drug resistance are unclear.
Objective: To identify risk factors for extensively drug-resistant tuberculosis and multidrug-resistant but non–extensively drug-resistant tuberculosis in patients with culture-confirmed pulmonary tuberculosis.
Design: Cross-sectional, countrywide study.
Setting: Estonia, a country with 1 of the world's highest rates of extensively drug-resistant and multidrug-resistant tuberculosis.
Patients: All patients with culture-confirmed pulmonary tuberculosis with clinical or radiologic evidence of active disease detected from January 2003 to December 2005.
Measurements: Risk determinants from patients' demographic characteristics, socioeconomic variables, and tuberculosis-related data or HIV status.
Results: Of 1163 patients, 60 (5.2%) had extensively drug-resistant tuberculosis and 196 (16.9%) had multidrug-resistant but non–extensively drug-resistant tuberculosis. Previous antituberculosis treatment (adjusted odds ratio [OR], 10.54 [95% CI, 5.97 to 18.62]), HIV infection (OR, 3.12 [CI, 1.31 to 7.41]), homelessness (OR, 2.73 [CI, 1.15 to 6.48]), and alcohol abuse (OR, 1.98 [CI, 1.08 to 3.64]) increased risk for extensive drug resistance. Previous treatment (OR, 4.11 [CI, 2.77 to 6.08]) and age 24 years or younger (OR, 2.57 [CI, 1.09 to 6.06]), 25 to 44 years (OR, 2.64 [CI, 1.35 to 5.16]), and 45 to 64 years (OR, 2.06 [CI, 1.06 to 3.99]) were determinants of multidrug resistance. In patients age 24 years or younger, female sex (OR, 6.23 [CI, 1.02 to 37.99]) and birth outside of Estonia (OR, 82.04 [CI, 3.46 to 1945.47]) increased risk for multidrug resistance.
Limitation: Patients' comorbid conditions and drug abuse history were not incorporated into analyses because of inconsistent source data.
Conclusion: Previous treatment is a common risk factor for extensively drug-resistant and multidrug-resistant tuberculosis. Reducing relapses; screening persons younger than 65 years and immigrants; and combating against HIV infection, alcoholism, and homelessness are key issues for decreasing the spread of highly drug-resistant tuberculosis.
Primary Funding Source: Estonian Health Insurance Fund.
Article and Author Information
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Acknowledgment: The authors acknowledge the valuable and professional assistance of Dr. Vahur Hollo and Tiina Kummik in data collection.
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Financial Support: By the Estonian Health Insurance Fund.
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Potential Financial Conflicts of Interest: None disclosed.
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Reproducible Research Statement: Study protocol: Available from Dr. Kliiman (e-mail, kai.kliiman{at}kliinikum.ee) or Dr. Altraja (e-mail, alan.altraja{at}kliinikum.ee). Statistical code: Available from Dr. Altraja (e-mail, alan.altraja{at}kliinikum.ee). Data set: Available from Dr. Kliiman (e-mail, kai.kliiman{at}kliinikum.ee).
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Requests for Single Reprints: Kai Kliiman, MD, Department of Pulmonary Medicine, University of Tartu, Riia 167, 51014 Tartu, Estonia; e-mail, kai.kliiman{at}kliinikum.ee.
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Current Author Addresses: Drs. Kliiman and Altraja: Department of Pulmonary Medicine, University of Tartu, Riia 167, 51014 Tartu, Estonia.
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Author Contributions: Conception and design: K. Kliiman, A. Altraja.
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Analysis and interpretation of the data: K. Kliiman, A. Altraja.
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Drafting of the article: K. Kliiman.
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Critical revision of the article for important intellectual content: K. Kliiman, A. Altraja.
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Final approval of the article: K. Kliiman, A. Altraja.
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Provision of study materials or patients: K. Kliiman.
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Statistical expertise: A. Altraja.
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Administrative, technical, or logistic support: A. Altraja.
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Collection and assembly of data: K. Kliiman.
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