Decline in rates of acquired multidrug-resistant tuberculosis after implementation of the directly observed therapy, short course (DOTS) and DOTS-Plus programmes in Taiwan
Journal
Journal of Antimicrobial Chemotherapy
Journal Volume
68
Journal Issue
8
Pages
1910-1916
Date Issued
2013
Author(s)
Abstract
Objectives: To investigate the impact of the directly observed therapy, short course (DOTS) and DOTS-Plus strategies on changes in resistance profiles among Mycobacterium tuberculosis (MTB). Methods: We performed a retrospective analysis of resistance profiles among isolates of MTB obtained from 2160 consecutive patients with culture-confirmed pulmonary tuberculosis (TB) between 2005 and 2011 at a referral centre in southern Taiwan. Results: Of the 2160 patients, 70 (3.2%) had primary multidrug-resistant (MDR)-TB, 178 (8.2%) had acquired MDR-TB, 10 (0.5%) had primary extensively drug-resistant (XDR)-TB, 23 (1.1%) had acquired XDR-TB and 5 (0.2%) had totally drug-resistant (TDR)-TB. Trend analysis revealed that the rates of acquired MDR-TB were significantly lower after implementation of the DOTS and DOTS-Plus programmes (P<0.01). There was a significant negative correlation between the coverage rates of the DOTS and DOTS-Plus programmes and the rates of acquired MDR-TB (r1/420.84, P1/40.02 and r1/420.92, P1/40.03, respectively). The rates of resistance to rifam-picin, isoniazid, ofloxacin, moxifloxacin, levofloxacin and para-aminosalicylic acid also decreased significantly during the study period. However, the rates of primary MDR-TB remained stable (P1/40.11). Multivariate logistic regression analysis showed that age ranging from 45 to 64 years, positive acid-fast stain results at the initiation of treatment and treatment without DOTS were independent risk factors associated with acquired MDR-TB. In addition, previous treatment for TB (100% versus 19% for TDR-TB and non-TDR-TB, P<0.01) and treatment without DOTS (80% versus 44% for TDR-TB and non-TDR-TB, P1/40.18) were risk factors for TDR-TB. Conclusions: DOTS and DOTS-Plus are both effective at preventing the acquisition of MDR-TB in Taiwan. ? The Author 2013. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.
SDGs
Other Subjects
aminosalicylic acid; capreomycin; ciprofloxacin; clarithromycin; clofazimine; cycloserine; ethambutol; ethionamide; isoniazid; kanamycin; levofloxacin; moxifloxacin; ofloxacin; protionamide; quinolone derivative; rifampicin; streptomycin; thymidine; adult; age; aged; antibiotic resistance; article; bacterium isolate; extensively drug resistant tuberculosis; female; health program; human; infection risk; lung tuberculosis; major clinical study; male; multidrug resistant tuberculosis; Mycobacterium tuberculosis; nonhuman; outcome assessment; retrospective study; short course therapy; Taiwan; acquired resistance; MDR-TB; totally drug-resistant tuberculosis; XDR-TB; Adult; Aged; Aged, 80 and over; Antitubercular Agents; Directly Observed Therapy; Disease Transmission, Infectious; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Mycobacterium tuberculosis; Prevalence; Retrospective Studies; Taiwan; Tuberculosis, Multidrug-Resistant; Young Adult
Type
journal article