title: Anti-tuberculosis drug resistance in Bangladesh: reflections from the first nationwide survey.
abstract: OBJECTIVE
  To determine the prevalence of tuberculosis (TB) drug resistance in Bangladesh.
  
  
  METHODS
  Weighted cluster sampling among smear-positive cases, and standard culture and drug susceptibility testing on solid medium were used.
  
  
  RESULTS
  Of 1480 patients enrolled during 2011, 12 falsified multidrug-resistant TB (MDR-TB) patients were excluded. Analysis included 1340 cases (90.5% of those enrolled) with valid results and known treatment antecedents. Of 1049 new cases, 12.3% (95%CI 9.3-16.1) had strains resistant to any of the first-line drugs tested, and 1.4% (95%CI 0.7-2.5) were MDR-TB. Among the 291 previously treated cases, this was respectively 43.2% (95%CI 37.1-49.5) and 28.5% (95%CI 23.5-34.1). History of previous anti-tuberculosis treatment was the only predictive factor for first-line drug resistance (OR 34.9). Among the MDR-TB patients, 19.2% (95%CI 11.3-30.5; exclusively previously treated) also showed resistance to ofloxacin. Resistance to kanamycin was not detected.
  
  
  CONCLUSIONS
  Although MDR-TB prevalence was relatively low, transmission of MDR-TB may be increasing in Bangladesh. MDR-TB with fluoroquinolone resistance is rapidly rising. Integrating the private sector should be made high priority given the excessive proportion of MDR-TB retreatment cases in large cities. TB control programmes and donors should avoid applying undue pressure towards meeting global targets, which can lead to corruption of data even in national surveys.
authors.affiliation: National Tuberculosis Reference Laboratory, National Institute of Diseases of the Chest and Hospital (NIDCH), Dhaka, Bangladesh.
authors.forename: S M M
authors.initials: SM
authors.lastname: Kamal
authors.affiliation: National TB Programme, Directorate General of Health Services, Ministry of Health & Family Welfare, Dhaka, Bangladesh.
authors.forename: A
authors.initials: A
authors.lastname: Hossain
authors.affiliation: National Professional Offices-World Health Organization (NPO-WHO), Dhaka, Bangladesh.
authors.forename: S
authors.initials: S
authors.lastname: Sultana
authors.affiliation: NPO-WHO, TB CARE-II, Dhaka, Bangladesh.
authors.forename: V
authors.initials: V
authors.lastname: Begum
authors.affiliation: National TB Programme, Directorate General of Health Services, Ministry of Health & Family Welfare, Dhaka, Bangladesh.
authors.forename: N
authors.initials: N
authors.lastname: Haque
authors.affiliation: Tuberculosis CARE-II, University Research Company, Dhaka, Bangladesh.
authors.forename: J
authors.initials: J
authors.lastname: Ahmed
authors.affiliation: Bangladesh Unnayan Parishad (BUP), Dhaka, Bangladesh.
authors.forename: T M A
authors.initials: TM
authors.lastname: Rahman
authors.affiliation: WHO South East Asia Regional Office, New Delhi, India.
authors.forename: K A
authors.initials: KA
authors.lastname: Hyder
authors.affiliation: National Tuberculosis Reference Laboratory, National Institute of Diseases of the Chest and Hospital (NIDCH), Dhaka, Bangladesh.
authors.forename: S
authors.initials: S
authors.lastname: Hossain
authors.affiliation: Tuberculosis CARE-II, University Research Company, Dhaka, Bangladesh.
authors.forename: M
authors.initials: M
authors.lastname: Rahman
authors.forename: Chowdhury R
authors.initials: CR
authors.lastname: Ahsan
authors.affiliation: Department of Microbiology, University of Dhaka, Dhaka, Bangladesh.
authors.forename: R A
authors.initials: RA
authors.lastname: Chowdhury
authors.affiliation: Damien Foundation, Dhaka, Bangladesh.
authors.forename: K J M
authors.initials: KJ
authors.lastname: Aung
authors.affiliation: BRAC, Dhaka, Bangladesh.
authors.forename: A
authors.initials: A
authors.lastname: Islam
authors.affiliation: NIDCH, Dhaka, Bangladesh.
authors.forename: R
authors.initials: R
authors.lastname: Hasan
authors.affiliation: Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Van Deun
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000494:pharmacology*; D001459:Bangladesh / Q000453:epidemiology; D003430:Cross-Sectional Studies; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D024841:Fluoroquinolones / Q000494:pharmacology*; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000302:isolation & purification; D015995:Prevalence; D013183:Sputum / Q000382:microbiology; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000453:epidemiology* / Q000635:transmission; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents; D024841:Fluoroquinolones