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Journal Article > Research

High time to use rapid tests to detect multidrug resistance in sputum smear-negative tuberculosis in Belarus

Rusovich V, Kumar AMV, Skrahina A, Hurevich H, Astrauko A, de Colombani P, Tayler-Smith K, Dara M, Zachariah R
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Abstract
SETTING
Belarus (Eastern Europe) is facing an epidemic of multidrug-resistant tuberculosis (MDR-TB). In 2012, rapid molecular diagnostics were prioritised for sputum smear-positive pulmonary tuberculosis (PTB) patients to diagnose MDR-TB, while pulmonary sputum smear-negative pulmonary TB (SN-PTB) patients were investigated using conventional methods, often delaying the diagnosis of MDR-TB by 2-4 months.

OBJECTIVE
To determine the proportion of MDR-TB among SN-PTB patients registered in 2012 and associated clinical and demographic factors.

DESIGN
Retrospective cohort study using countrywide data from the national electronic TB register.

RESULTS
Of the 5377 TB cases registered, 2960 (55%) were SN-PTB. Of the latter, 1639 (55%) were culture-positive, of whom 768 (47%) had MDR-TB: 33% (363/1084) were new and 73% (405/555) previously treated patients. Previous history of treatment, age, region, urban residence, human immunodeficiency virus (HIV) status and being a pensioner were independently associated with MDR-TB.

CONCLUSION
About half of culture-positive SN-PTB patients have MDR-TB and this rises to over 7/10 for retreatment cases. A national policy decision to extend rapid molecular diagnostics universally to all PTB patients, including SN-PTB, seems justified. Steps need to be taken to ensure implementation of this urgent priority, given the patient and public health implications of delayed diagnosis.
Countries
Belarus
Subject Area
antibiotic resistancetuberculosisSORT-ITantimicrobial resistance
DOI
10.5588/pha.14.0069
Published Date
21-Dec-2014
PubMed ID
26400703
Languages
English
Journal
Public Health Action
Volume / Issue / Pages
Volume 4, Issue 4, Pages 243-8
Issue Date
21-Dec-2014
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