Soedarsono Soedarsono, Ni Made Mertaniasih, Titiek Sulistyowati

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Multidrug-resistant tuberculosis (MDR-TB) is a global public health crisis. Acid-fast bacilli (AFB) gradation in sputum examination is an important component in Pulmonary Tuberculosis (PTB) diagnosis and treatment outcome monitoring. Previously treated pulmonary TB patients with a higher AFB smear gradation may have higher rates of acquired resistance. Patients with a higher AFB grade indicate a higher bacillary load and had higher rates of acquired resistance. This study aims to evaluate the correlation between AFB gradation and first-line anti-TB drug resistance patterns in MDR pulmonary TB patients. This was a retrospective study conducted from August 2009 to April 2018 in Dr. Soetomo Hospital. Sputum samples were taken from MDR PTB patients. Sputum smear examination was done using Ziehl–Neelsen staining and gradation was measured according to IUATLD criteria. Samples with positive smear were evaluated for resistance patterns based on culture and resistance tests using the MGIT 960 BACTEC System. There were 433 sputum samples with AFB positive collected from MDR PTB patients. Resistance to RHES was found in 22 (14%) AFB +1, 19 (15%) AFB +2, and 29 (20%) AFB +3. Resistance to RHS was found in 22 (14%) AFB +1, 12 (9%) AFB +2, and 13 (9%) AFB +3. Resistance to RHE was found in 39 (25%) AFB +1, 38 (29%) AFB +2, and 35 (24%) AFB +3. Resistance to RH was found in 74 (47%) AFB +1, 61 (47%) AFB +2, and 69 (47%) AFB +3. Statistic analysis by Spearman test showed that there was no significant correlation between AFB gradation and first-line anti-TB drug resistance patterns. Acquired resistance to RHES can also found in lower bacillary load AFB +1.


MDR pulmonary TB, AFB grading, first line anti-TB drug resistance pattern.

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World Health Organization. Global Tuberculosis Report 2018.Geneva: WHO; 2018.

World Health Organization. Multidrug and extensively drug-resistant TB (M/XDR-TB): Global report on surveillance and response. Jenewa: WHO; 2010

Fox GJ, Schaaf HS, Mandalakas A, Chiappini E, Zumla A, Marais BJ. Preventing the spread of multidrug-resistant tuberculosis and protecting contacts of infectious cases. Clin Microbiol and Infect. 2017; 23: 147-53.

Kang HK, Jeong BH, Lee H, Park HY, Jeon K, Huh HJ, et al. Clinical significance of smear positivity for acid-fast bacilli after ≥5 months of treatment in patients with drug-susceptible pulmonary tuberculosis. Medicine. 2016; 95(31): e4540.

Kempker RR, Kipiani M, Mirtskhulava V, Tukvadze N, Magee MJ, Blumberg HM. Acquired Drug Resistance in Mycobacterium tuberculosis and Poor Outcomes among Patients with Multidrug-Resistant Tuberculosis. Emerging Infect Dis. 2015; 21(6): 992-1001.

McGrath M, van Pittius NCG, van Helden PD, Warren RM, Warner DF. Mutation rate and the emergence of drug resistance in Mycobacterium tuberculosis. J Antimicrob Chemother. 2014; 69: 292-302.

Colijn C, Cohen T, Ganesh A, Murray M. Spontaneous emergence of multiple drug resistance in tuberculosis before and during therapy. PLoS One. 2011; 6: e18327.

Dominguez J, Boettger EC, Cirillo D, Cobelens F, Eisenach KD, Gagneux S, et al. Clinical implications of molecular drug resistance testing for Mycobacterium tuberculosis: a TBNET/RESIST-TB consensus statement. Int J Tuberc Lung Dis. 2016; 20(1): 24-42.

Singhal R, Arora J, Sah GC, Bhalla M, Sarin R, Myneedu VP. Frequency of multi-drug resistance and mutations in Mycobacterium tuberculosis isolates from Punjab state in India. J Epidemiol Glob Health. 2017; 7: 175-80.

Zignol M, van Gemert W, Falzon D, Sismanidis C, Glaziou P, Floyd K, et al. Surveillance of anti-tuberculosis drug resistance in the world: an updated analysis, 2007e2010. Bulletin of the World Health Organization 2012; 90: 111De9D.

Lomtadze N, Aspindzelashvili R, Janjgava M, Mirtskhulava V, Wright A, Blumberg HM, et al. Prevalence and risk factors for multidrug-resistant tuberculosis in Republic of Georgia: a population based study. Int J Tuberc Lung Dis. 2009; 13(1): 68–73.

Caminero JA. Multidrug-resistant tuberculosis: epidemiology, risk factors and case finding. Int J Tuberc Lung Dis. 2010; 14(4): 382-90.

Hafez SA, Elhefnawy AM, Hatata EA, El Ganady AA, Ibrahiem MI. Detection of extensively drug resistant pulmonary tuberculosis. Egypt J Chest Dis Tuberc. 2013; 62(4): 635-46.

Eshetie S, Gizachew M, Dagnew M, Kumera G, Woldie H, Ambaw F, et al. Multidrug resistant tuberculosis in Ethiopian settings and its association with previous history of anti-tuberculosis treatment: a systematic review and meta-analysis. BMC Infectious Diseases. 2017; 17: 219.

Kumar P, Kumar P, Balooni V, Singh S. Genetic mutations associated with rifampicin and isoniazid in MDR-TB patients in North-West India. Int J Tuberc Lung Dis. 2015; 19(4): 434-9.

Odubanjo MO, Dada-Adegbola H.O. The microbiological diagnosis of tuberculosis in a resource-limited setting: is acid-fast bacilli microscopy alone sufficient?. Ann. Ibd. Pg. Med. 2011; 9(1): 24-9.

Sander MS, Vuchas CY, Numfor HN, Nsimen AN, Abena JL, Noeske J. Sputum bacterial load predicts multidrug-resistant tuberculosis in retreatment patients: a case-control study. Int J Tuberc Lung Dis. 2016; 20(6): 793-9.

Dookie N, Rambaran S, Padayatchi N, Mahomed S, Naidoo K. Evolution of drug resistance in Mycobacterium tuberculosis: a review on the molecular determinants of resistance and implications for personalized care. J Antimicrob Chemother. 2018; 73: 1138-51.

Goswami A, Chakraborty U, Mahaputra T, Mahapatra S, Mukherjee T, Das S, et al. Correlates on treatment outcomes and drug resistance among pulmonary tuberculosis patients attending tertiary care hospitals of Kolkata, India. PLoS ONE. 2014; 9(10): e109563.

Ford CB, Shah RR, Maeda MK, Gagneux S, Murray MB, Cohen T, et al. Mycobacterium tuberculosis mutation rate estimates from different lineages predict substantial differences in the emergence of drug resistant tuberculosis. Nat Genet. 2013; 45(7); 784-90.


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