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

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

doi:10.33073/pjm-2022-018

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

Polish Journal of Microbiology

Volume 71 (2022): Issue 2 (June 2022)

By: Khairallah A.S. Mohammed , Ghorob S. Khudhair and Dheyaa Bekheet Al-Rabeai

Open Access

|May 2022

Figures & Tables

Table I

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)

[i] OR –Odds Ratio, TB –Tuberculosis, DR-TB –Drug-Resistant Tuberculosis, CI –Confidence Intervals

Table II

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

[i] RIF – Rifampin, INH – Isoniazid, EMB – Ethambutol, SM – Streptomycin, TB – Tuberculosis,

DR-TB – Drug-Resistant Tuberculosis, MR-TB – Mono-Drug Resistant Tuberculosis,

MDR-TB – Multi-Drug Resistant Tuberculosis, PDR-TB – Poly-Drug Resistant Tuberculosis

Table III

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

[i] $\begin{aligned} Primary drug resistance rate (%) = \frac{the number of each D R - T B subcategories}{the total of corresponding primary TB cases in the same year}) \times 100 % \\ The % changes = \frac{incidence in 2020 - incidence in 2017}{incidence in 2017} \end{aligned}$

* – the column (2016) is not included in the calculation

DR-TB – Drug-Resistant Tuberculosis, MR-TB – Mono-Drug Resistant Tuberculosis,

MDR-TB – Multi-Drug Resistant Tuberculosis, PDR-TB – Poly-Drug Resistant Tuberculosis,

EMB – Ethambutol, INH – Isoniazid, RFP – Rifampin, SM – Streptomycin

Table IV

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

[i] $\begin{aligned} Secondary drug resistance rate (%) = \frac{the number of each D R - T B subcategories}{the total of corresponding primary TB cases in the same year}) \times 100 % \\ The % changes = \frac{incidence in 2020 - incidence in 2016}{incidence in 2016} \end{aligned}$

DR-TB – Drug-Resistant Tuberculosis, MR-TB – Mono-Drug Resistant Tuberculosis,

MDR-TB – Multi-Drug Resistant Tuberculosis, PDR-TB – Poly-Drug Resistant Tuberculosis,

EMB – Ethambutol, INH – Isoniazid, RFP – Rifampin, SM – Streptomycin.

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DOI: https://doi.org/10.33073/pjm-2022-018 | Journal eISSN: 2544-4646 | Journal ISSN: 1733-1331

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Language: English

Page range: 205 - 215

Submitted on: Jan 17, 2022

Accepted on: Mar 12, 2022

Published on: May 31, 2022

Published by: Polish Society of Microbiologists

In partnership with: Paradigm Publishing Services

Publication frequency: 4 issues per year

Keywords:

Mycobacterium tuberculosis,

MDR-TB,

Related subjects:

Microbiology and virology

© 2022 Khairallah A.S. Mohammed, Ghorob S. Khudhair, Dheyaa Bekheet Al-Rabeai, published by Polish Society of Microbiologists
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Volume 71 (2022): Issue 2 (June 2022)

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

Figures & Tables

Fig. 1

Table I

Table II

Table III

Table IV

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