Surveillance of drug-resistant tuberculosis in the state of Gujarat , India .

Ranjani. R.; Nalini, S.; Chandrasekar, V.; Dave, P.V.; Sanghvi, A.S.; Wares, F.; Paramasivan, C.N.; Narayanan, P.R.; Sahu, S.; Parmar, M.; Chadha, S.; Dewan, P.; Chauhan, L.S.

International Journal of Tuberculosis and Lung Disease; 2009; 13; 1154-1160.

Summary: Background: Limited information about the prevalence of drug-resistant tuberculosis (TB) has been reported from India , the country with the world's highest burden of TB. We conducted a representative state-wide survey in the state of Gujarat (2005 population: 56 million).

Methods: Mycobacterium tuberculosis isolates from a representative sample of new and previously treated smear-positive pulmonary TB (PTB) cases were subjected to drug susceptibility testing (DST) against first-line drugs at a World Health Organization supranational reference laboratory. Isolates found to have at least both isoniazid (INH) and rifampicin (RMP) resistance (i.e., multidrug-resistant TB [MDR-TB]) were subjected to second-line DST.

Results: Of 1571 isolates from new patients, 1236 (78.7%) were susceptible to all first-line drugs, 173 (11%) had any INH resistance and MDR-TB was found in 37 (2.4%, 95%CI 1.6–3.1). Of 1047 isolates from previously treated patients, 564 (54%) were susceptible to all first-line drugs, 387 (37%) had any INH resistance and MDR-TB was found in 182 (17.4%, 95%CI 15.0–19.7%). Among 216 MDR-TB isolates, 52 (24%) were ofloxacin (OFX) resistant; seven cases of extensively drug-resistant TB (XDR-TB) were found, all of whom were previously treated cases.

Conclusion: MDR-TB prevalence remains low among new TB patients in Gujarat , but is more common among previously treated patients. Among MDR-TB isolates, the alarmingly high prevalence of OFX resistance may threaten the success of the expanding efforts to treat and control MDR-TB.

Keywords: tuberculosis; drug resistance; India

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