Abstract:
Background. Acquired Resistance to WHO Group A second-line drugs like bedaquiline and
linezolid is a new threat to treatment outcomes in patients with multi-drug resistant
tuberculosis (MDR-TB). To improve treatment success and prevent resistance amplification,
identifying patient-level risk factors is critical.
Objective(s). To assess the clinical and sociodemographic factors associated with MDR-TB
patients with treatment failure and acquired resistance to WHO Group A second-line drugs
under the National TB program-PNRT.
Materials and methods. This retrospective cohort study included patients with
microbiologically confirmed pulmonary MDR-TB treated under PNRT between 01.01.2021
and 31.12.2022. Patients were grouped by presence/absence of acquired drug resistance.
Variables analysed included age, sex, HIV status, education, residence, prior-TB and
radiographic findings.
Results. There were no significant differences between groups in age, sex, HIV co-infection,
urban residence, homelessness, or cavitary lesions on chest imaging. However, all patients
with acquired resistance had a history of prior TB infection (19/19; 100%), compared to
those without infection 20/29 (69.0%) (p=0.007). Lower secondary education was more
prevalent among those with acquired resistance (68.4%) compared to those without
(27.6%) (p=0.008).
Conclusion(s). Previous episodes of TB and lower secondary education were more frequent
in patients with acquired resistance to WHO group A second-line drugs. To reduce resistance
in high risk MDR-TB populations, enhanced adherence strategies and targeted education
efforts are needed.
