Surveillance of drug-resistant tuberculosis in the state of Gujarat, India.
BACKGROUND
Limited information about the prevalence of drug-resistant tuberculosis (TB) has been reported from India, the country with the world's highest burden of TB. We conducted a representative state-wide survey in the state of Gujarat (2005 population: 56 million).


METHODS
Mycobacterium tuberculosis isolates from a representative sample of new and previously treated smear-positive pulmonary TB (PTB) cases were subjected to drug susceptibility testing (DST) against first-line drugs at a World Health Organization supranational reference laboratory. Isolates found to have at least both isoniazid (INH) and rifampicin (RMP) resistance (i.e., multidrug-resistant TB [MDR-TB]) were subjected to second-line DST.


RESULTS
Of 1571 isolates from new patients, 1236 (78.7%) were susceptible to all first-line drugs, 173 (11%) had any INH resistance and MDR-TB was found in 37 (2.4%, 95%CI 1.6-3.1). Of 1047 isolates from previously treated patients, 564 (54%) were susceptible to all first-line drugs, 387 (37%) had any INH resistance and MDR-TB was found in 182 (17.4%, 95%CI 15.0-19.7%). Among 216 MDR-TB isolates, 52 (24%) were ofloxacin (OFX) resistant; seven cases of extensively drug-resistant TB (XDR-TB) were found, all of whom were previously treated cases.


CONCLUSIONS
MDR-TB prevalence remains low among new TB patients in Gujarat, but is more common among previously treated patients. Among MDR-TB isolates, the alarmingly high prevalence of OFX resistance may threaten the success of the expanding efforts to treat and control MDR-TB.
Ramachandran
R
R
Tuberculosis Research Centre, Chennai, India. ranjanir@trcchennai.in
Nalini
S
S
Chandrasekar
V
V
Dave
P V
PV
Sanghvi
A S
AS
Wares
F
F
Paramasivan
C N
CN
Narayanan
P R
PR
Sahu
S
S
Parmar
M
M
Chadha
S
S
Dewan
P
P
Chauhan
L S
LS
D000995:Antitubercular Agents; D001431:Bacteriological Techniques; D015169:Colony Count, Microbial; D024901:Drug Resistance, Multiple, Bacterial; D005000:Ethionamide; D054908:Extensively Drug-Resistant Tuberculosis / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007538:Isoniazid; D007612:Kanamycin; D008297:Male; D008856:Microscopy, Fluorescence; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000302:isolation & purification; D015242:Ofloxacin; D011159:Population Surveillance; D015995:Prevalence; D012293:Rifampin; D013183:Sputum / Q000382:microbiology; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology
D000995:Antitubercular Agents; D007612:Kanamycin; D015242:Ofloxacin; D005000:Ethionamide; D007538:Isoniazid; D012293:Rifampin