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

Mohammed, Khairallah A.S.; Khudhair, Ghorob S.; Al-Rabeai, Dheyaa Bekheet

doi:10.33073/pjm-2022-018

Figures & Tables

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
Characteristics	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)	856.23
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
Characteristics	*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)	204.54
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)

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

Figures & Tables

Fig. 1

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

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

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

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

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