Linkage of presumptive multidrug resistant tuberculosis (MDR-TB) patients to diagnostic and treatment services in Cambodia

PLoS One. 2013 Apr 25;8(4):e59903. doi: 10.1371/journal.pone.0059903. Print 2013.

Abstract

Setting: National Tuberculosis Programme, Cambodia.

Objective: In a cohort of TB patients, to ascertain the proportion of patients who fulfil the criteria for presumptive MDR-TB, assess whether they underwent investigation for MDR-TB, and the results of the culture and drug susceptibility testing (DST).

Methods: A cross sectional record review of TB patients registered for treatment between July-December 2011.

Results: Of 19,236 TB patients registered, 409 (2%) fulfilled the criteria of presumptive MDR-TB; of these, 187 (46%) were examined for culture. This proportion was higher among relapse, failure, return after default (RAD) and non-converters at 3 months of new smear positive TB patients (>60%) as compared to non-converters at 2 months of new TB cases (<20%). Nearly two thirds (n = 113) of the samples were culture positive; of these, three-fourth (n = 85) grew Mycobacterium tuberculosis complex (MTBc) and one-fourth (n = 28) grew non-tuberculous Mycobacteria. DST results were available for 96% of the MTBc isolates. Overall, 21 patients were diagnosed as MDR-TB (all diagnosed among retreatment TB cases and none from non-converters) and all of them were initiated on MDR-TB treatment.

Conclusion: There is a need to strengthen mechanisms for linking patients with presumptive MDR-TB to culture centers. The policy of testing non-converters for culture and DST needs to be reviewed.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cambodia
  • Cross-Sectional Studies
  • Culture Techniques
  • Diagnostic Services*
  • Drug Resistance, Multiple*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Sputum / microbiology
  • Tuberculosis, Pulmonary / diagnosis*
  • Tuberculosis, Pulmonary / drug therapy
  • Tuberculosis, Pulmonary / therapy*

Grants and funding

The study was mainly supported by WPRO of WHO and WHO Cambodia for national ethical clearance, data collection, data analysis, wrote manuscript, dissemination, and follow up. Funding for the operational research training course came from an anonymous donor and the Department for International Development, UK. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.