Pathophysiology

doi: 10.25005/2074-0581-2018-20-2-3-293-298
COMPARATIVE ANALYSIS OF MTB STRAINS WITH DIFFERENT TYPES OF DRUG RESISTANCE IN PULMONARY TUBERCULOSIS IN THE KYRGYZ REPUBLIC

A.A. Toktogonova1, A.A. Asambaev2

1Therapeutic Department, National Center for Phthisiology, Bishkek, Kyrgyz Republic
2Medical Center of the I.K. Akhunbaev Kyrgyz State Medical Academy, Bishkek, Kyrgyz Republic

Objective: A comparative analysis of the frequencies of MTB strains with different types of drug resistance (DR) among different contingents of pulmonary tuberculosis in the Kyrgyz Republic for 2 years.

Methods: The results of tests for drug sensitivity (TDS) of the TB agent have been studied according to the data of the National Reference Laboratory, bacteriological laboratories of Bishkek and Osh cities that conducted TDS for the regions of the Kyrgyz Republic for 2016-2017.

Results: Among TB patients registered in 2017 in compare with 2016 year, statistically significant less frequently registered case (р<0,001, c², OR=1.237, 95% CI 1.13-1.63 vs. 1211 cases in 2016 year). MTB complexes using the Xpert-MTB/RIF method were identified in 2017 more (706/11.7% vs. 574/9.0%, р<0,001, c², OR=1.341, 95% CI 1.19-1.51), but the resistance of MTB to rifampicin was diagnosed 1.8 times less (299/52.1% versus 270/38.2%, р<0,001, c², OR=1.756, 95% CI 1.40-2.19). It was found that in 2017, sensitive strains were registered less often (1012/38.7% versus 1138/43.1%, p=0.002, c², OR=1.199, 95% CI 1.07-1.34) and more often strains of TB with XDR (127/4.8% versus 72/2.7%, р<0,001, c², OR=1.821, 95% CI 1.36-2.44) than in 2016. Reduction of strains with preserved sensitivity of MBT is observed due to their decrease among new ones (р<0,001, c², OR=1,183, 95% CI 1.04-1.35) and previously treated cases of TB (p=0.048, c², OR=1.439, 95% CI 1.00-2.06). The increase in strains of TB with XDR is 2.7 times higher among new cases (21/1.2% vs 8/0.4%, p=0.020, c², with Yates correction, OR=2.745, 95% CI 1.21-6.21), and among previously treated TB 1.5 times (p=0.028, c², OR=1.519, 95% CI 1.04-2.21).

Conclusion: The results of the conducted studies indicate that the proportion of sensitive strains of TB tendency to decrease. The situation of MDR-TB in the country is unfavourable and has not changed in two years, moreover, in 2017 there was a 1.8-fold increase in strains of TB with XDR (p<0,001), especially 2.7 times in new cases (p=0.020) than in 2016.

Keywords: Tuberculosis, drug sensitivity tests, MTB strains, resistance, MDR-TB, XDR-TB.

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References
  1. Alisherov АА. Epidemiologiya i profilaktika tuberkulyoza v penitentsiarnykh uchrezhdeniyakh Kyrgyzstana [Epidemiology and prevention of tu-berculosis in penitentiary institutions in Kyrgyzstan]. Meditsinskie kadry XXI veka. 2011;1:5-8.
  2. Alisherov ASh, Esentaeva E. Informatsiya po mnozhestvennomu lekarstvenno-ustoychivomu tuberkulyozu (MLU TB) v Kyrgyzskoy Respublike [Information on multiple drug-resistant tuberculosis (MDR-TB) in the Kyrgyz Republic]. Meditsinskie kadry XXI veka. 2011;1:60-4.
  3. Kadyrov AS. Epidemiologicheskaya situatsiya po tuberkulyozu v Kyrgyzskoy Respublike v 2012-2016 godakh [Epidemiological situation of tuberculosis in the Kyrgyz Republic 2012-2016]. Nauka, novye tekhnologii i innovatsii Kyrgyzstana. 2017;8:3-7.
  4. Moydunova NK, Kalmambetova GI. Test Xpert MTB/Rif v diagnostike tuberkulyoznykh serozitov [Xpert MTB/Rif test in the diagnosis of tuberculous serosites]. Nauka, novye tekhnologii i innovatsii Kyrgyzstana. 2017;8:44-6.
  5. Kim CW, Kim SH, Lee SN. Risk factors related with mortality in patient with pulmonary tuberculosis. Tuberc & Respir Dis. 2012;38:47. https://www.ncbi.nlm.nih.gov /pubmedcentral.
  6. Van Deun A, Maug AKJ, Salim MAH, Das PK, Sarker MR, Daru P, et al. Short, highly effective, and inexpensive standardized treatment of multidrug-resistant tuberculosis. Am J Respir Crit Care Med. 2010;182:684-92.
  7. Ahmad S, Mokaddas E. Current status and future trends in the diagnosis and treatment of drug-susceptible and multidrug-resistant tuberculosis. J Infect Public Health. 2014;7(2):75-91. Available from: http://dx.doi.org/10.1016/j.jiph.2013.09.001.
  8. Bastos ML, Hussain H, Weyer K. Treatment outcomes of patients with multidrug- and extensive drug-resistant tuberculosis according to drug susceptibility testing to first- and secondline drugs: an individual patient data meta-analysis. Clin Infect Dis. 2014;59:1364-74.
  9. Cegielski JP, Dalton T, Yagui M. Extensive drug resistance acquired during treatment of multidrug-resistant tuberculosis. Clin Infect Dis. 2014;59:1049-63.
  10. Kim DH, Kim HJ, Park S, Kong S, Kim YS, Kim T, et al. Treatment outcomes and survival based on drug resistance patterns in multidrug-resistant tuberculosis. Am J Respir Crit Care Med. 2010;182:113-9.
  11. Chan ED, Strand MJ, Iseman MD. Multidrug-resistant tuberculosis (TB) resistant to fluoroquinolones and streptomycin but susceptible to secondline injection therapy has a better prognosis than extensively drug-resistant TB. Clin Infect Dis. 2009;48:50-2.
  12. Migliori GB, Lange C, Centis R, Sotgiu G, Mütterlein R, Hoffmann H, et al. Resistance to secondline injectables and treatment outcomes in multidrug-resistant and extensively drug-resistant tuberculosis cases. Eur Respir J. 2008;31:1155-9.
  13. Migliori GB, Lange C, Girardi E, Centis R, Besozzi G, Kliiman K, et al. Fluoroquinolones: are they essential to treat multidrug-resistant tuberculosis? Eur Respir J. 2008;31:904-5.

Authors' information:


Toktogonova Atyrkul Akmatbekovna,
Candidate of Medical Sciences, Leading Researcher of the Therapeutic Department, National Center for Phthisiology

Asambaev Abdykadyr Asambaevich,
Candidate of Medical Sciences, Associate Professor, Phthisiatrician of the Medical Center, I.K. Akhunbaev Kyrgyz State Medical Academy

Conflicts of interest: No conflict

Address for correspondence:


Toktogonova Atyrkul Akmatbekovna

Candidate of Medical Sciences, Leading Researcher of the Therapeutic Department, National Center for Phthisiology

720020, Kyrgyz Republic, Bishkek, Akhunbaev str., 90a

Tel.: (+996) 771 110117

E-mail: atyrkul7@gmail.com

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