title: High prevalence of primary drug resistance in children with intrathoracic tuberculosis in India.
abstract: Drug susceptibility testing (DST) of Mycobacterium tuberculosis (Mtb) isolates is crucial for the effective treatment of tuberculosis. Data on DST patterns in Mtb isolates in childhood tuberculosis are scanty.
  
  
  
  To determine drug resistance patterns in Mtb isolates from a paediatric TB cohort in North India.
  
  
  
  403 children aged 6 months to14 year with probable intrathoracic tuberculosis were enrolled prospectively. All were treatment-naïve. 802 ambulatory-induced sputa (IS) and 787 gastric aspirate (GA) samples were cultured in BACTEC-MGIT960 system, and DST of the Mtb isolates was undertaken using the automated BACTEC-MGIT960 SIRE kit.
  
  
  
  Of the 403 children, 147 (36.4%) were culture-confirmed: 132 (89.8%) isolates were Mtb and 15 (10.2%) non-tuberculous mycobacteria (NTM). Five Mtb isolates were contaminated and the remaining 127 were subjected to in-vitro drug susceptibility testing against streptomycin, isoniazid, rifampicin and ethambutol. Twenty-six (20.47%) isolates were resistant to one or more drugs, seven (5.5%) were resistant to rifampicin singly or in combination, and 11 (8.7%) were resistant to isoniazid singly or in combination. Mono-resistance to isoniazid, rifampicin, streptomycin and ethambutol was detected in four (3.1%), one (0.8%), four (3.1%) and two (1.6%), respectively. Five children (3.9%) had MDR-TB; 101 (79.9%) children had Mtb isolates which were sensitive to all four drugs.
  
  
  
  The rifampicin and isoniazid resistance rates were much higher than those in the adult TB population in India.
authors.affiliation: a Division of Clinical Microbiology and Molecular Medicine , Department of Laboratory Medicine.
authors.forename: Suneel
authors.initials: S
authors.lastname: Prajapati
authors.affiliation: a Division of Clinical Microbiology and Molecular Medicine , Department of Laboratory Medicine.
authors.forename: Kriti
authors.initials: K
authors.lastname: Upadhyay
authors.affiliation: b Department of Paediatrics , All India Institute of Medical Sciences.
authors.forename: Aparna
authors.initials: A
authors.lastname: Mukherjee
authors.affiliation: b Department of Paediatrics , All India Institute of Medical Sciences.
authors.forename: S K
authors.initials: SK
authors.lastname: Kabra
authors.affiliation: b Department of Paediatrics , All India Institute of Medical Sciences.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Lodha
authors.affiliation: c Department of Paediatrics , Kalawati Saran Children Hospital , New Delhi , India.
authors.forename: Varinder
authors.initials: V
authors.lastname: Singh
authors.affiliation: d Section of Microbiology and Immunology, The Gade Institute, University of Bergen and Department of Microbiology , Haukeland University Hospital , Bergen , Norway.
authors.forename: Harleen M S
authors.initials: HM
authors.lastname: Grewal
authors.affiliation: a Division of Clinical Microbiology and Molecular Medicine , Department of Laboratory Medicine.
authors.forename: Sarman
authors.initials: S
authors.lastname: Singh
mesh_terms: D000293:Adolescent; D000995:Antitubercular Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D008297:Male; D008826:Microbial Sensitivity Tests; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000302:isolation & purification*; D015995:Prevalence; D011446:Prospective Studies; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology
chemical_list: D000995:Antitubercular Agents
keywords: Gastric lavage; India; Induced sputum; Multi-drug-resistant TB; Rifampicin; Tuberculosis