title: Correlates of treatment outcomes and drug resistance among pulmonary tuberculosis patients attending tertiary care hospitals of Kolkata, India.
abstract: BACKGROUND
  Worldwide highest number of new pulmonary tuberculosis (PTB) cases, was reported from India in 2012. Adverse treatment outcomes and emergence of drug resistance further complicated the prevailing scenario owing to increased duration, cost and toxicity associated with the treatment of drug-resistant cases. Hence to reinforce India's fight against TB, identification of the correlates of adverse treatment outcomes and drug resistance, seemed critical.
  
  
  METHODS
  To estimate the associations between diagnostic findings, patient types (based on treatment outcomes), drug resistance and socio-demographic characteristics of PTB patients, a cross-sectional study was conducted in two tertiary-care hospitals in Kolkata between April 2010 and March 2013. Altogether, 350 consenting Mycobacterium tuberculosis sputum-culture positive PTB patients were interviewed about their socio-demographic background, evaluated regarding their X-ray findings (minimal/moderately advanced/far advanced/cavities), sputum-smear positivity, and treatment history/outcomes (new/defaulter/relapse/treatment-failure cases). Multiple-allele-specific polymerase chain reaction (MAS-PCR) was conducted to diagnose drug resistance.
  
  
  RESULTS
  Among all participants, 31.43% were newly diagnosed, while 44%, 15.43% and 9.14% patients fell into the categories of relapsed, defaulters and treatment-failures, respectively. 12.29% were multi-drug-resistant (MDR: resistant to at least isoniazid and rifampicin), 57.71% had non-MDR two-drug resistance and 12% had single-drug resistance. Subjects with higher BMI had lower odds of being a relapse/defaulter/treatment failure case while females were more likely to be defaulters and older age-groups had more relapse. Elderly, females, unmarried, those with low BMI and higher grade of sputum-smear positivity were more likely to have advanced X-ray features. Higher grade of sputum-smear positivity and advanced chest X-ray findings were associated with relapse/treatment-failures. Elderly, unmarried, relapse/defaulter/treatment-failure cases had higher odds and those with higher BMI and moderately/far advanced X-ray findings had lower odds of having MDR/non-MDR two-drug resistant PTB.
  
  
  CONCLUSIONS
  Targeted intervention and appropriate counseling are needed urgently to prevent adverse treatment outcomes and development of drug resistance among PTB patients in Kolkata.
authors.affiliation: Institute of Postgraduate Medical Education & Research, Kolkata, India.
authors.forename: Avranil
authors.initials: A
authors.lastname: Goswami
authors.affiliation: Institute of Postgraduate Medical Education & Research, Kolkata, India.
authors.forename: Urmita
authors.initials: U
authors.lastname: Chakraborty
authors.affiliation: Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America.
authors.forename: Tanmay
authors.initials: T
authors.lastname: Mahapatra
authors.affiliation: Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America.
authors.forename: Sanchita
authors.initials: S
authors.lastname: Mahapatra
authors.affiliation: Burdwan Medical College & Hospital, Burdwan, India.
authors.forename: Tapajyoti
authors.initials: T
authors.lastname: Mukherjee
authors.affiliation: Bose Institute, Kolkata, India.
authors.forename: Shibali
authors.initials: S
authors.lastname: Das
authors.affiliation: Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America.
authors.forename: Aritra
authors.initials: A
authors.lastname: Das
authors.affiliation: Calcutta National Medical College, Kolkata, India.
authors.forename: Subir Kumar
authors.initials: SK
authors.lastname: Dey
authors.affiliation: SSKM Hospital, Kolkata, India.
authors.forename: Sudhin
authors.initials: S
authors.lastname: Ray
authors.affiliation: Institute of Postgraduate Medical Education & Research, Kolkata, India.
authors.forename: Basudev
authors.initials: B
authors.lastname: Bhattacharya
authors.affiliation: Institute of Postgraduate Medical Education & Research, Kolkata, India.
authors.forename: Nishith Kumar
authors.initials: NK
authors.lastname: Pal
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000995:Antitubercular Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007194:India; D007538:Isoniazid / Q000627:therapeutic use; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000502:physiology; D011859:Radiography; D012008:Recurrence; D012293:Rifampin / Q000627:therapeutic use; D012737:Sex Factors; D012923:Social Class; D013183:Sputum / Q000382:microbiology; D063128:Tertiary Health Care; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000382:microbiology
chemical_list: D000995:Antitubercular Agents; D007538:Isoniazid; D012293:Rifampin