title: Multidrug resistant Mycobacterium tuberculosis amongst Category I & II failures and Category II relapse patients from Pakistan.
abstract: OBJECTIVE
  To determine the prevalence of multidrug-resistant tuberculosis (MDR-TB) among previously treated TB patients in Khyber Pakhtunkhwa (KP) Province, Pakistan.
  
  
  METHODS
  A cross-sectional study was conducted (January-September 2009) in 10 districts of KP. All Category (CAT) I and CAT II failures, and CAT II relapse cases were recruited within 1week following declaration of treatment outcome or re-registration of CAT II. Clinical information and sputum was collected from each patient.
  
  
  RESULTS
  Total 139 patients were enrolled. Mycobacterium tuberculosis bacilli (MTB) was isolated in 113 (81.3%) samples; Mycobacterium other than tuberculosis (MOTT) was isolated in 7 (5%) samples. MDR-TB was noted in 66 (58.4%) patients and extensive drug resistant (XDR-TB) in 2 (1.8%) patients. Amongst MDR patients, 20 (62.5%) were CAT I failure, 19 (76%) CAT II failure and 27 (48.2%) CAT II relapse cases. Resistance to Isoniazid was most common in 84 (74%) cases, followed by Pyrazinamide in 73 (64.6%) cases, Rifampicin in 67 (59%) cases, Streptomycin in 60 (53%) cases, Ethambutol in 58 (51%) cases, and Ofloxacin in 18 (22.2%) cases.
  
  
  CONCLUSIONS
  High rate of drug resistance, including MDR observed among failures and relapse cases. This study emphasizes the need to review TB care delivery, particularly in failure cases in difficult regions such as KP that have seen considerable population displacement and conflict in recent years.
authors.affiliation: Koninklijke Nederlandse Centrale Verneniging Tot Bestrujding Der Tuberculose (KNCV) Tuberculosis Foundation, Pakistan. Electronic address: GhafoorA@kncvtbc.nl.
authors.forename: Abdul
authors.initials: A
authors.lastname: Ghafoor
authors.affiliation: Dept. of Pathology and Microbiology, Aga Khan University, Pakistan. Electronic address: jaishri.mehraj@aku.edu.
authors.forename: Jaishri
authors.initials: J
authors.lastname: Mehraj
authors.affiliation: AGEG/GTZ Strengthening the Tuberculosis Control Programme in North West Frontier Province/Federally Administered Tribal Areas, Pakistan (AGEG/GTZ STCP), Pakistan. Electronic address: n.afridi@ageg.de.
authors.forename: Nek Dad
authors.initials: ND
authors.lastname: Afridi
authors.affiliation: Dept. of Pathology and Microbiology, Aga Khan University, Pakistan. Electronic address: yasraba.rafiq@aku.edu.
authors.forename: Yasraba
authors.initials: Y
authors.lastname: Rafiq
authors.affiliation: AGEG/GTZ Strengthening the Tuberculosis Control Programme in North West Frontier Province/Federally Administered Tribal Areas, Pakistan (AGEG/GTZ STCP), Pakistan. Electronic address: uwewendl@web.de.
authors.forename: Hans-Uwe
authors.initials: HU
authors.lastname: Wendl-Richter
authors.affiliation: Dept. of Pathology and Microbiology, Aga Khan University, Pakistan. Electronic address: rumina.hasan@aku.edu.
authors.forename: Rumina
authors.initials: R
authors.lastname: Hasan
keywords: Drug resistance; Pakistan; Treatment failures; Treatment relapses; Tuberculosis