Predictors of Multidrug Resistance Among Pulmonary Tuberculosis Patients in a Tertiary Hospital in North Sumatera, Indonesia
Kusumawati, R. Lia
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Background: Previous tuberculosis treatment for tuberculosis is known to confer a higher risk of multidrug-resistant tuberculosis (MDR-TB). Indonesia is ranked eighth among the 27 “high-burden” MDR-TB countries. Objectives: This study aimed to determine the predictors of multi-drug resistance among patients with pulmonary tuberculosis in Indonesia. Methods: This retrospective study was conducted in a tertiary referral teaching hospital in Medan, North Sumatera Province, Indonesia. Laboratory data and medical histories of all pulmonary tuberculosis patients attending the hospital were reviewed. Patients with culture positive for Mycobacterium tuberculosis and processed for drug-susceptibility testing (DST) to first-line anti-tuberculosis drugs between January 2010 and December 2013 were included. Logistic regression was used to determine significant predictors of MDR-TB based on odds ratios (OR) and 95% confidence intervals (CI). Results: Of 6,174 patients with suspected pulmonary tuberculosis, 842 were confirmed positive by culture, of which DST results were reported for 765. Of these, 115 (15%) had diabetes mellitus, 73 (9.5%) were HIV-infected, and 98 (12.8%) were MDR-TB. Multivariate analysis indicated that patients with a history of previous tuberculosis treatment (OR = 3.75; 95% C.I. = 2.40 - 5.86 and aged 25 to 45 years (OR = 2.37; 95% C.I. = 1.07 - 5.27) were significant predictors of MDR-TB. Conclusions: Previous tuberculosis treatment and age 25-45 were significant predictors of MDR-TB. Treating patients with previous tuberculosis treatment based on DST results should be considered.