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Increasing Prevalence of Pediatric Drug-resistant Tuberculosis in Mumbai, India, and Its Outcome

Shah, Miti A., MS, DNB*; Shah, Ira, MD, DNB, FCPS, DCH, DPID

The Pediatric Infectious Disease Journal: December 2018 - Volume 37 - Issue 12 - p 1261–1263
doi: 10.1097/INF.0000000000002040
Antimicrobial Reports
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Background: The prevalence and type of Drug resistant tuberculosis (DR-TB) was evaluated pre- and post-2013, and outcome was studied.

Methods: Descriptive retrospective study. Children were defined as having DR-TB on the basis of GeneXpert or line probe assay and/or drug susceptibility testing (DST) of M. tuberculosis grown on culture or from contact’s DST.

Results: The prevalence of DR-TB was 110 of 1145 cases (9.6%), which showed an increase, compared with 5.6% pre-2010 and 7% in 2010–2013 (P = 0.014408). Twenty-two children (20%) had pulmonary-TB and 88 (80%) had extra-pulmonary-TB with disseminated-TB being the most common presentation in 31 children (28.18%). Ninety-six children (87.3%) were bacteriologically confirmed TB cases, and 14 (12.7%) were clinically diagnosed-TB and treated as per contact DST. Eight cases (7.2%) were monoresistant, 7 (6.3%) polyresistant, MDR-TB seen in 28 patients (25.45%), 32 (29.09%) had pre-XDR-TB, 9 (8.18%) had XDR-TB and 12 (10.9%) were rifampicin resistant. Ethionamide resistance increased from 26.1% pre-2013 to 60.8% post-2013 (P = 0.014408) and ofloxacin resistance rose from 30.4% pre-2010, to 47.6% in 2010–2013 and 56.9% post-2013 (P = 0.080863). Moxifloxacin resistance showed an acute rise from 8.7% pre-2010, to 46% in 2010–2013 and 57% post-2013 (P = 0.000275). Thirty-three patients (30%) had completed their treatment, 21 (19.09%) were lost to follow-up and 56 (50.09%) patients are still on treatment.

Conclusions: DR-TB is increasing in Mumbai, India. Based on the DST results, individualised therapy would be recommended.

From the *Seth GS Medical College and KEM Hospital

B.J.Wadia Hospital, Mumbai, Maharashtra, India.

Accepted for publication February 28, 2018.

The study was approved by the institutional ethics committee.

The authors have no conflicts of interest or funding to disclose.

I.S. designed the study, M.S. did data collection and statistical analysis, I.S. and M.S. wrote the article and did review of the literature. I.S. will act as guarantor of the study.

Address for correspondence: Ira Shah, Head, Pediatric Infectious Diseases and Incharge, Pediatric TB Clinic, B J Wadia Hospital for Children, Mumbai, India. E-mail: irashah@pediatriconcall.com.

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