title: Drug-resistant tuberculosis in South African gold miners: incidence and associated factors.
abstract: METHODS
  A gold mining company in the Free State Province of South Africa.
  
  
  OBJECTIVE
  To document the incidence of and factors associated with drug-resistant tuberculosis (TB) in South African gold miners.
  
  
  METHODS
  Review of Mycobacterium tuberculosis drug susceptibility records for the period from 1 July 1993 to 30 June 1997.
  
  
  RESULTS
  Over the study period, 2241 miners had culture-positive M. tuberculosis pulmonary disease where isolates were tested for drug susceptibility to the four primary anti-tuberculosis drugs. The proportions of primary and acquired drug resistance were respectively 7.3% and 14.3% for isoniazid and 1.0% and 2.8% for resistance to at least isoniazid and rifampicin (multidrug resistance). Resistance to streptomycin and ethambutol was uncommon, and rifampicin monoresistance was rare. No significant factors for primary drug resistance were identified. Patients with retreatment pulmonary TB who failed primary TB treatment (versus cure) were significantly more likely to have TB with resistance to any TB drug or MDR (odds ratios respectively 9.82, 95%CI 2.97-33.5, and 18.74, 95%CI 1.76-475). Human immunodeficiency virus (HIV) infection was not significantly associated with primary or acquired drug resistance, and there was no trend of increasing resistance over time.
  
  
  CONCLUSIONS
  Anti-tuberculosis drug resistance has remained stable despite the HIV epidemic and increasing TB rates. Directly observed therapy may have contributed to containing the level of drug resistance. Adherence to and completion of treatment are essential to prevent drug resistance and treatment failure, including in situations with high HIV prevalence.
authors.affiliation: Aurum Health Research, Welkom, South Africa. gchurch@mjvn.co.za
authors.forename: G J
authors.initials: GJ
authors.lastname: Churchyard
authors.forename: E L
authors.initials: EL
authors.lastname: Corbett
authors.forename: I
authors.initials: I
authors.lastname: Kleinschmidt
authors.forename: D
authors.initials: D
authors.lastname: Mulder
authors.forename: K M
authors.initials: KM
authors.lastname: De Cock
mesh_terms: D000328:Adult; D017677:Age Distribution; D000995:Antitubercular Agents / Q000008:administration & dosage; D016001:Confidence Intervals; D006679:HIV Seropositivity; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008906:Mining / Q000706:statistics & numerical data*; D009169:Mycobacterium tuberculosis / Q000187:drug effects; D016017:Odds Ratio; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*
chemical_list: D000995:Antitubercular Agents