title: Drug susceptibility profiles of pulmonary Mycobacterium tuberculosis isolates from patients in informal urban settlements in Nairobi, Kenya.
abstract: Anti-tuberculosis drug resistance is an emerging health problem in Kenya and especially in slums. Slum environments create a conducive environment for the spread of tuberculosis (TB) due to high population density and lack of basic amenities such as decent housing, access to clean water, lack of drainage and basic sanitation. Furthermore, ineffective health services in crowded and poorer populations, poor patient compliance, a large pool of untreated cases, delayed diagnosis and inappropriate treatment regimens are likely to favour selection and spread of drug resistant Mycobacterium tuberculosis (Mtb) strains in such settings, however, precise data on this problem are only sparsely available. To address this question, this study aimed at determining drug resistance patterns of Mtb strains obtained from pulmonary TB patients who sought health care in randomly selected informal settings.
  
  
  
  This is a cross-sectional study conducted between September 2014 and March 2015, sputum samples were collected from 223 consenting adult patients and subjected to primary isolation and drug susceptibility testing. Socio-demographic data was collected and all data analysed using SPSS v20.
  
  
  
  Drug susceptibility testing against first line drugs was successfully carried out on 184 isolates. Resistance to at-least one drug was observed in 33 % of the isolates. The highest prevalence of resistance to any drug was identified against isoniazid,(INH) (23.9 %) followed by Ethambutol (EMB) (13.6 %). The highest proportion of mono resistance was observed against INH, 25 (13.6 %). Multidrug resistance (MDR) was observed in 4.4 % of the new cases. There was no significant difference in the proportion of any resistance by sex, age or previous treatment.
  
  
  
  Levels of drug resistance have reached an alarming level in this population. Capacity of laboratories to conduct TB culture and DST should be strengthened in order to adequately manage TB patients and stop further creation and spread of MDR TB.
authors.affiliation: Molecular and Experimental Mycobacteriology, Research Center Borstel, Borstel, Germany. glenakerubo@gmail.com.|Centre for Respiratory Disease Research, Kenya Medical Research Institute, Nairobi, Kenya. glenakerubo@gmail.com.
authors.forename: Glennah
authors.initials: G
authors.lastname: Kerubo
authors.affiliation: Centre for Respiratory Disease Research, Kenya Medical Research Institute, Nairobi, Kenya.
authors.forename: Evans
authors.initials: E
authors.lastname: Amukoye
authors.affiliation: Molecular and Experimental Mycobacteriology, Research Center Borstel, Borstel, Germany.|German Centre for Infection Research (DZIF), partner site Borstel, Borstel, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Niemann
authors.affiliation: Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.
authors.forename: Samuel
authors.initials: S
authors.lastname: Kariuki
mesh_terms: D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000494:pharmacology* / Q000627:therapeutic use; D002947:Cities; D003430:Cross-Sectional Studies; D024881:Drug Resistance, Bacterial / Q000187:drug effects*; D004977:Ethambutol / Q000494:pharmacology; D005260:Female; D006801:Humans; D007538:Isoniazid / Q000494:pharmacology; D007630:Kenya; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000302:isolation & purification; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy / Q000382:microbiology*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents; D004977:Ethambutol; D007538:Isoniazid
keywords: Drug resistance; Informal settlements; Mycobacterium tuberculosis