title: Rise in rifampicin-monoresistant tuberculosis in Western Cape, South Africa.
abstract: METHODS
  Brewelskloof Hospital, Western Cape, South Africa.
  
  
  OBJECTIVE
  To verify the perceived increase in rifampicin monoresistant tuberculosis (RMR-TB) in the Cape Winelands-Overberg region and to identify potential risk factors.
  
  
  METHODS
  A retrospective descriptive study of trends in RMR-TB over a 5-year period (2004-2008), followed by a case-control study of RMR and isoniazid (INH) monoresistant TB cases, diagnosed from April 2007 to March 2009, to assess for risk factors.
  
  
  RESULTS
  The total number of RMR-TB cases more than tripled, from 31 in 2004 to 98 in 2008. The calculated doubling time was 1.63 years (95%CI 1.18-2.66). For the assessment of risk factors, 95 RMR-TB cases were objectively verified on genotypic and phenotypic analysis. Of 108 specimens genotypically identified as RMR cases, 13 (12%) were misidentified, multidrug-resistant TB. On multivariate analysis, previous use of antiretroviral therapy (OR 6.4, 95%CI 1.3-31.8), alcohol use (OR 4.8, 95%CI 2.0-11.3) and age ≥ 40 years (OR 5.8, 95%CI 2.4-13.6) were significantly associated with RMR-TB.
  
  
  CONCLUSIONS
  RMR-TB is rapidly increasing in the study setting, particularly among patients with advanced human immunodeficiency virus (HIV) disease. Routine drug susceptibility testing should be considered in all TB-HIV co-infected patients, and absence of INH resistance should be confirmed phenotypically if genotypic RMR-TB is detected.
authors.affiliation: Department of Interdisciplinary Health Sciences, Clinical Epidemiology, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa. fi delekmukinda@gmail.com
authors.forename: F K
authors.initials: FK
authors.lastname: Mukinda
authors.forename: D
authors.initials: D
authors.lastname: Theron
authors.forename: G D
authors.initials: GD
authors.lastname: van der Spuy
authors.forename: K R
authors.initials: KR
authors.lastname: Jacobson
authors.forename: M
authors.initials: M
authors.lastname: Roscher
authors.forename: E M
authors.initials: EM
authors.lastname: Streicher
authors.forename: A
authors.initials: A
authors.lastname: Musekiwa
authors.forename: G J
authors.initials: GJ
authors.lastname: Coetzee
authors.forename: T C
authors.initials: TC
authors.lastname: Victor
authors.forename: B J
authors.initials: BJ
authors.lastname: Marais
authors.forename: J B
authors.initials: JB
authors.lastname: Nachega
authors.forename: R M
authors.initials: RM
authors.lastname: Warren
authors.forename: H S
authors.initials: HS
authors.lastname: Schaaf
mesh_terms: D000328:Adult; D000904:Antibiotics, Antitubercular / Q000627:therapeutic use; D004269:DNA, Bacterial / Q000032:analysis; D003937:Diagnosis, Differential; D024881:Drug Resistance, Bacterial; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D012189:Retrospective Studies; D012293:Rifampin / Q000627:therapeutic use*; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis
chemical_list: D000904:Antibiotics, Antitubercular; D004269:DNA, Bacterial; D012293:Rifampin