Multidrug-resistant tuberculosis in Bangladesh: results from a sentinel surveillance system.
Multidrug-resistant tuberculosis (MDR-TB) is a serious obstacle to successful TB control. The 2010-2011 Bangladesh Drug Resistance Survey (DRS) showed MDR-TB prevalence to be 7% overall, 1.4% in new and 28.5% in previously treated patients. We aimed to determine the rate of MDR-TB in selected sentinel sites in Bangladesh.



Fourteen hospitals from the seven divisions in Bangladesh were selected as sentinel surveillance sites. Newly registered TB patients were systematically enrolled from August 2011 to December 2014. Sputum specimens were processed for culture and drug susceptibility testing by the proportion method using Löwenstein-Jensen medium.



Specimens from 1906 (84%) of 2270 enrolled patients were analysed. Isolates from 61 (3.2%) were identified as having MDR-TB. The proportion of MDR-TB was 2.3% among new and 13.8% among previously treated TB patients (P < 0.001). The overall proportion of MDR-TB was 3.2%:3.5% in males and 2.3% in females; by age, the MDR-TB rate was highest (5.2%) in those aged 65 years.



The high proportion of MDR-TB among new patients found in this sentinel surveillance significantly differs from that reported in the DRS. While the sentinel surveillance sites were not designed to be nationally representative, it is worrying to observe a higher number of MDR-TB cases among new patients.
International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
S
S
Banu
International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
M T
MT
Rahman
International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
S
S
Ahmed
International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
R
R
Khatun
International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
S S
SS
Ferdous
International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka.
B
B
Hosen
National TB Control Programme, Directorate General of Health Services, Mohakhali, Dhaka, Bangladesh.
M M
MM
Rahman
International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
T
T
Ahmed
Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
J S
JS
Cavanaugh
International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh; Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
J D
JD
Heffelfinger
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000627:therapeutic use; D001459:Bangladesh / Q000453:epidemiology; D002648:Child; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D012042:Registries; D012307:Risk Factors; D018571:Sentinel Surveillance; D013183:Sputum / Q000382:microbiology; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D055815:Young Adult
D000995:Antitubercular Agents