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Prevalence and Drug Resistance Pattern of Mycobacterium tuberculosis Isolated from Tuberculosis Patients in Basra, Iraq

Khairallah A.S. Mohammed
Khairallah A.S. Mohammed
, 
Ghorob S. Khudhair
Ghorob S. Khudhair
 et 
Dheyaa Bekheet Al-Rabeai
Dheyaa Bekheet Al-Rabeai
   | 31 mai 2022
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Article Category: Original Paper
Publié en ligne: 31 mai 2022
Pages: 205 - 215
Reçu: 17 janv. 2022
Accepté: 12 mars 2022
DOI: https://doi.org/10.33073/pjm-2022-018
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© 2022 Khairallah A.S. Mohammed et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Fig. 1

Districts of Basra Governorate.
Districts of Basra Governorate.

The time-based change trend of secondary drug resistance rate amongst retreated diagnosed TB cases in Basra, Iraq, 2016–2020.

Characteristics Secondary drug resistance rate Change
2016 n = 81 2017 n = 51 2018 n = 51 2019 n = 41 2020 n = 22 856.23
DR-TB (Total) 5 (6.17) 8 (15.6) 10 (19.6) 14 (34.1) 13 (59)
Type
MR-TB 1 (1.2) 1 (1.9)   2 (3.9)   0   1 (4.5)   275
MDR-TB 3 (3.7) 6 (11.7)   3 (5.8) 12 (29.2) 11 (50) 1 251.35
PDR-TB 1 (1.2) 1 (1.9)   5 (9.8)   2 (4.8)   1 (4.5)   275
Age (years)
≤ 14 0 0   0   0   0   0
15–34 2 (8.6) 3 (30)   4 (21)   6 (40)   4 (44.4)   416.27
35–54 1 (4) 2 (12.5)   4 (26.6)   4 (30.7)   7 (87.5) 2 087.5
≥ 55 2 (6.6) 3 (13)   2 (11.7)   4 (30.7)   2 (40)   506.06
Sex
Female 2 (4.7) 3 (15.7)   4 (13.3) 11 (45.8)   5 (62.5) 1129.78
Male 3 (7.6) 5 (15.6)   6 (28.5)   3 (17.6)   8 (57.1)   651.31
First-line drugs
INH 4 (4.9) 6 (11.8)   6 (11.8) 14 (34) 12 (54.5)    10.12
RIF 4 (4.9) 6 (11.8)   5 (9.8) 12 (29.3) 12 (54.5)    10.12
EMB 1 (1.2) 4 (7.8)   5 (9.8)   5 (12.2)   6 (27.3)    21.75
SM 1 (1.2) 5 (9.8)   5 (9.8)   7 (17)   6 (27.3)    21.75

The time-based change trend of primary drug resistance rate amongst newly diagnosed TB patients in Basra, Iraq, 2016–2020.

Characteristics Primary drug resistance rate Change
*2016 n = 512 2017 n = 584 2018 n = 490 2019 n = 410 2020 n = 300 204.54
DR-TB (Total) 1 (0.1) 13 (2.2) 5 (1) 15 (3) 20 (6.7)
Type
MR-TB 0   5 (0.85) 2 (0.4)   9 (2) 12 (4) 370.58
MDR-TB 0   1 (0.17) 1 (0.2)   1 (0.2)   5 (1.6) 841.17
PDR-TB 1 (0.1)   7 (1.19) 2 (0.4)   5 (1.2)   3 (1) –15.96
Age (years)
≤ 14 0   1 (1.6) 0   0   1 (3.1)   93.75
15–34 1 (0.6)   4 (1.9) 2 (1.08)   6 (4.1)   8 (7.1) 273.68
35–54 0   4 (2.58) 2 (1.45)   2 (1.63)   6 (7.14) 176.74
≥ 55 0   4 (2.54) 1 (0.85)   7 (7.2)   5 (7.04) 177.16
Sex
Female 1 (0.46)   5 (1.75) 3 (1.2) 10 (4.9) 10 (8.13) 364.57
Male 0   8 (2.67) 2 (0.8)   5 (2.4) 10 (5.64) 111.23
First-line drugs
INH 1 (0.19)   5 (0.85) 3 (0.61)   8 (1.95)   6 (2)    1.35
RIF 0   1 (0.17) 2 (0.4)   3 (0.73) 12 (4)   22.5
EMB 0   6 (1) 1 (0.2)   5 (1.21)   1 (0.3)   –0.7
SM 1 (0.19) 11 (1.9) 2 (0.4)   5 (1.21) 11 (3.7)   18.47

Primary and acquired drug resistance profiles of Mycobacterium tuberculosis strains, Basra, Iraq 2016–2020.

Drug resistance New cases n = 2296 (%) Retreated cases n = 246 (%) p-value
DR-TB 54 (2.4) 50 (20.3) 0.0001
Any resistance to first-line drugs
INH 23 (1) 42(17.1) 0.0001
RIF 18 (0.78) 39 (15.8) 0.0001
EMB 13 (0.56) 21 (8.5) 0.011
SM 30 (1.3) 24 (9.75) 0.007
MR-TB (Total) 28 (1.22)   5 (2) 0.564
INH   4 (0.17)   0 0.102
RIF   7 (0.3)   3 (1.2) 0.206
EMB   4 (0.17)   1 (0.4) 0.180
SM 13 (0.56)   1 (0.4) 0.001
MDR-TB (Total)   8 (0.34) 35 (14.2) 0.0001
MDR1: INH + RIF   7 (0.3) 20 (8.1) 0.011
MDR2: INH + RIF +EMB   0   2 (0.81) 0.317
MDR3: INH + RIF + EMB + SM   1 (0.04) 12 (4.8) 0.002
MDR4: INH + RIF + SM   0   1 (0.4) 0.564
PDR-TB (Total) 18 (0.78) 10 (4.1) 0.257
PDR1: INH + EMB   2 (0.08)   0 1.000
PDR2: INH + SM   7 (0.3)   3 (1.2) 0.564
PDR3: RIF + EMB   0   0 –
PDR4: RIF + SM   3 (0.13)   1 (0.4) 1.000
PDR5: INH + EMB + SM   2 (0.08)   4 (1.6) 0.317
Others (SM + EMB)   4 (0.17)   2 (0.81) 0.564

Demographic and clinical characteristics of new and retreated tuberculosis patients, Basra, Iraq, 2016-2020.

New cases Retreated cases New cases vs. Retreated cases Primary DR-TB vs. Acquired DR
Characteristics Total n = 2296 DR-TB n = 54 (2.4) Susceptible TB n = 2242 (97.6) OR (95% CI) p-value Total n = 246 DR-TB n = 50 (20.3) Susceptible TBn=196 (79.7) OR (95% CI) p-value OR (95% CI) p-value OR (95% CI) p-value
Age
< 14 254 2 252 0.233 0.051 5 0 5 0.431 0.576 7.748 <0.0001 3.974 0.384
(11) (3.7) (11.23) (0.054-1.008) (2) (2.6) (0.023-8.207) (3.109-19.308) (0.178-89.003)
15-34 804 21 783 0.788 0.458 76 19 57 1.622 0.212 1.613 0.004 0.873 0.771
(35) (38.9) (34.9) (0.420-1.479) (30.8) (38) (29.1) (0.758-3.470) (1.166-2.233) (0.348-2.186)
35-54 661 12 649 0.543 0.102 77 16 61 1.277 0.541 1.309 0.105 0.592 0.308
(28.7) (22.2) (28.9) (0.261-1.129) (31.3) (32) (31.12) (0.584-2.791) (0.945-1.813) (0.216-1.624)
>55 577 19 558 Ref. Ref. 88 15 73 Ref. Ref. Ref. Ref. Ref. Ref.
(25.1) (35.2) (24.9) (35.7) (30) (37.2)
Sex
Female 1076 29 1047 1.324 0.310 123 25 98 1.000 1.000 0.882 0.349 1.16 0.706
(46.8) (53.7) (46.7) (0.771-2.275) (50) (50) (50) (0.537-1.861) (0.678-1.147) (0.537-2.506)
Male 1220 25 1195 Ref. Ref. 123 25 98 Ref. Ref. Ref. Ref. Ref. Ref
(53.1) (46.3) (53.3) (50) (50) (50).
Smoking
Yes 580 13 567 0.937 0.839 70 15 55 1.099 0.786 0.850 0.276 0.740 0.497
(25.3) (24.1) (25.3) (0.498-1.761) (28.4) (30) (28.1) (0.556-2.170) (0.634-1.139) (0.310-1.764)
No 1716 41 1675 Ref. Ref. 176 35 141 Ref. Ref. Ref. Ref. Ref. Ref.
(74.7) (75.9) (74.7) (71.5) (70) (71.9)
Cavity
Yes 710 32 678 1.018 0.950 153 39 114 0.958 0.917 0.372 <0.0001 0.391 0.038
(30.9) (59.6) (30.6) (0.580-1.788) (62.1) (78) (58.2) (0.428-2.150) (0.256-0.541) (0.161-0.948)
No 474 21 453 Ref. Ref. 38 1 28 Ref. Ref. Ref. Ref. Ref. Ref.
(20.6) (38.9) (20.2) (15.4) (20) (14.3)
Infiltration
Yes 308 13 295 0.921 0.801 50 13 37 1.025 0.948 0.992 0.962 0.9 0.817
(13.4) (24.1) (13.2) (0.486-1.746) (20.3) (26) (18.9) (0.490-2.140) (0.700-1.404) (0.369-2.194)
No 876 4 836 Ref. Ref. 141 36 105 Ref. Ref. Ref. Ref. Ref. Ref.
(38.1) (74.1) (37.3) (57.3) (72) (53.6)
Other abnormalities
Yes 142 6 136 0.934 0.878 23 6 17 1.026 0.960 0.995 0.985 0.915 0.885
(6.1) (11.1) (6.04) (0.392-2.226) (9.3) (12) (8.7) (0.380-2.770) (0.622-1.592) (0.274-3.052)
No 1042 47 995 Ref. Ref. 168 43 125 Ref. Ref. Ref. Ref. Ref. Ref.
(45.3) (87) (44.4) (68.2) (86) (63.8)
Clear
Yes 4 1 3 7.23 0.089 0 0 0 2.879 0.598 1.46 0.800 2.829 0.527
(0.17) (1.9) (0.13) (0.739-70.71) (0.056-147.03) (0.078-27.227) (0.113-71.087)
No 118 52 1128 Ref. Ref. 191 49 142 Ref. Ref. Ref. Ref. Ref. Ref.
(51.3) (96.3) (50.3) (77.6) (98) (72.4)
Type
Extra 1112 1 1111 Ref. Ref. 55 1 54 Ref. Ref. Ref. Ref. Ref. Ref.
pulmonary TB (48.4) (1.9) (49.6) (22.3) (2) (27.6)
Pulmonary TB 118 53 1131 52.062 0.0001 191 49 142 18.634 0.004 0.307 <0.0001 1.082 0.956
(51.5) (98.1) (50.4) (7.19-377.13) (77.6) (98) (72.4) (2.51-138.31) (0.225-0.418) (0.066-17.768)
Region
Urban 993 32 961 1.939 0.018 87 27 60 2.661 0.003 1.393 0.018 1.239 0.589
(43.2) (59.3) (42.9) (1.12-3.358) (35.3) (54) (30.6) (1.412-5.015) (1.059-1.832) (0.570-2.965)
Rural 1303 2 1281 Ref. Ref. 159 23 136 Ref. Ref. Ref. Ref. Ref. Ref.
(56.7) (40.7) (57.1) (64.6) (46) (69.4)
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