Rise in rifampicin-monoresistant tuberculosis in Western Cape, South Africa
OBJECTIVES: To verify the perceived increase in rifampicin monoresistant tuberculosis (RMR-TB) in the Cape Winelands-Overberg region and to identify potential risk factors.
DESIGN: A retrospective descriptive study of trends in RMR-TB over a 5-year period (2004–2008), followed by a case-control study of RMR and isoniazid (INH) monoresistant TB cases, diagnosed from April 2007 to March 2009, to assess for risk factors.
RESULTS: The total number of RMR-TB cases more than tripled, from 31 in 2004 to 98 in 2008. The calculated doubling time was 1.63 years (95%CI 1.18–2.66). For the assessment of risk factors, 95 RMR-TB cases were objectively verified on genotypic and phenotypic analysis. Of 108 specimens genotypically identified as RMR cases, 13 (12%) were misidentified, multidrug-resistant TB. On multivariate analysis, previous use of antiretroviral therapy (OR 6.4, 95%CI 1.3–31.8), alcohol use (OR 4.8, 95%CI 2.0–11.3) and age ≥40 years (OR 5.8, 95%CI 2.4–13.6) were significantly associated with RMR-TB.
CONCLUSION: RMR-TB is rapidly increasing in the study setting, particularly among patients with advanced human immunodeficiency virus (HIV) disease. Routine drug susceptibility testing should be considered in all TB-HIV co-infected patients, and absence of INH resistance should be confirmed phenotypically if genotypic RMR-TB is detected.
Keywords: South Africa; monoresistant; rifampicin; tuberculosis
Document Type: Research Article
Affiliations: 1: Department of Interdisciplinary Health Sciences, Clinical Epidemiology, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa 2: Brewelskloof Hospital, Worcester, South Africa 3: Centre for Molecular and Cellular Biology, Stellenbosch University and the South African Medical Research Council, Cape Town, South Africa 4: Massachusetts General Hospital, Boston, Massachusetts, USA 5: Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa 6: National Health Laboratory Services, Cape Town, South Africa 7: Department of Paediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University, South Africa; Desmond Tutu TB Centre, Faculty of Health Sciences, Stellenbosch University, South Africa 8: Department of Medicine and Centre for Infectious Diseases, Faculty of Health Sciences, Stellenbosch University, South Africa; Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
Publication date: 01 February 2012
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