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. 2005 Feb;60(2):130–135. doi: 10.1136/thx.2004.026922

Rates of drug resistance and risk factor analysis in civilian and prison patients with tuberculosis in Samara Region, Russia

M Ruddy 1, Y Balabanova 1, C Graham 1, I Fedorin 1, N Malomanova 1, E Elisarova 1, S Kuznetznov 1, G Gusarova 1, S Zakharova 1, A Melentyev 1, E Krukova 1, V Golishevskaya 1, V Erokhin 1, I Dorozhkova 1, F Drobniewski 1
PMCID: PMC1747303  PMID: 15681501

Abstract

Background: Tuberculosis (TB) and HIV rates continue to escalate in Russia, but true rates for drug resistance, especially multidrug resistant tuberculosis (MDR TB), are unknown. A study was conducted with the aims of identifying first line drug resistance, both in the civilian and prison sectors, for new and previously treated cases; and risk factors for the development of drug resistance.

Methods: A cross sectional survey was undertaken of 600 patients (309 civilians, 291 prisoners) with bacteriologically confirmed pulmonary TB over a 1 year period during 2001–2 in Samara Oblast, Russia.

Results: The prevalence of isoniazid, rifampicin, streptomycin, ethambutol and pyrazinamide resistance in new TB cases (civilian and prison patients) was 38.0%, 25.2%, 34.6%, 14.7%, and 7.2%, respectively. The prevalence of MDR TB was 22.7%, 19.8%, and 37.3% in all new cases, new civilian cases, and new prison cases, respectively, with an overall prevalence of 45.5% and 55.3% in previously treated cases. Factors associated with resistance included previous TB treatment for more than 4 weeks, smoking (for isoniazid resistance), the presence of cavitations on the chest radiograph, and imprisonment. HIV was not associated with resistance in all patients. The rates of resistance were significantly higher in prisoners, with rate ratios (RR) of 1.9 (95% CI 1.1 to 3.2) for MDR TB, 1.9 (95% CI 1.1 to 3.2) for rifampicin, and 1.6 (95% CI 1.0 to 2.6) for isoniazid.

Conclusions: Rates of first line drug resistance are high, particularly in prisoners and previously treated cases. TB control programmes should initially focus on standardised treatment to maximise cure, combined with measures to reduce institutional TB spread (particularly in prisons) coupled with early diagnosis of MDR TB to reduce the spread and development of resistance.

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Selected References

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  1. Alexandrova Anna. Russia: new criminal process code promises a more tolerant incarceration policy. Can HIV AIDS Policy Law Rev. 2003 Apr;8(1):54–54. [PubMed] [Google Scholar]
  2. Canetti G., Fox W., Khomenko A., Mahler H. T., Menon N. K., Mitchison D. A., Rist N., Smelev N. A. Advances in techniques of testing mycobacterial drug sensitivity, and the use of sensitivity tests in tuberculosis control programmes. Bull World Health Organ. 1969;41(1):21–43. [PMC free article] [PubMed] [Google Scholar]
  3. Coker R. J., Dimitrova B., Drobniewski F., Samyshkin Y., Balabanova Y., Kuznetsov S., Fedorin I., Melentsiev A., Marchenko G., Zakharova S. Tuberculosis control in Samara Oblast, Russia: institutional and regulatory environment. Int J Tuberc Lung Dis. 2003 Oct;7(10):920–932. [PubMed] [Google Scholar]
  4. Coker Richard. Should tuberculosis programmes invest in second-line treatments for multidrug-resistant tuberculosis (MDR-TB)? Int J Tuberc Lung Dis. 2002 Aug;6(8):649–650. [PubMed] [Google Scholar]
  5. Coninx R., Maher D., Reyes H., Grzemska M. Tuberculosis in prisons in countries with high prevalence. BMJ. 2000 Feb 12;320(7232):440–442. doi: 10.1136/bmj.320.7232.440. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Djuretic T., Herbert J., Drobniewski F., Yates M., Smith E. G., Magee J. G., Williams R., Flanagan P., Watt B., Rayner A. Antibiotic resistant tuberculosis in the United Kingdom: 1993-1999. Thorax. 2002 Jun;57(6):477–482. doi: 10.1136/thorax.57.6.477. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Drobniewski F. A., Balabanova Yanina M. The diagnosis and management of multiple-drug-resistant-tuberculosis at the beginning of the new millenium. Int J Infect Dis. 2002 Mar;6 (Suppl 1):S21–S31. doi: 10.1016/s1201-9712(02)90151-7. [DOI] [PubMed] [Google Scholar]
  8. Drobniewski F., Eltringham I., Graham C., Magee J. G., Smith E. G., Watt B. A national study of clinical and laboratory factors affecting the survival of patients with multiple drug resistant tuberculosis in the UK. Thorax. 2002 Sep;57(9):810–816. doi: 10.1136/thorax.57.9.810. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Drobniewski F. Tuberculosis in prisons--forgotten plague. Lancet. 1995 Oct 7;346(8980):948–949. doi: 10.1016/s0140-6736(95)91562-1. [DOI] [PubMed] [Google Scholar]
  10. Drobniewski Francis, Balabanova Yanina, Ruddy Michael, Fedorin Ivan, Melentyev Alexander, Mutovkin Evgeny, Kuznetzov Sergey. Medical and social analysis of prisoners with tuberculosis in a Russian prison colony: an observational study. Clin Infect Dis. 2003 Jan 15;36(2):234–235. doi: 10.1086/345530. [DOI] [PubMed] [Google Scholar]
  11. Dye Christopher, Espinal Marcos A., Watt Catherine J., Mbiaga Cyrille, Williams Brian G. Worldwide incidence of multidrug-resistant tuberculosis. J Infect Dis. 2002 Apr 1;185(8):1197–1202. doi: 10.1086/339818. [DOI] [PubMed] [Google Scholar]
  12. Dye Christopher, Williams Brian G., Espinal Marcos A., Raviglione Mario C. Erasing the world's slow stain: strategies to beat multidrug-resistant tuberculosis. Science. 2002 Mar 15;295(5562):2042–2046. doi: 10.1126/science.1063814. [DOI] [PubMed] [Google Scholar]
  13. Espinal M. A., Kim S. J., Suarez P. G., Kam K. M., Khomenko A. G., Migliori G. B., Baéz J., Kochi A., Dye C., Raviglione M. C. Standard short-course chemotherapy for drug-resistant tuberculosis: treatment outcomes in 6 countries. JAMA. 2000 May 17;283(19):2537–2545. doi: 10.1001/jama.283.19.2537. [DOI] [PubMed] [Google Scholar]
  14. Johnson A. M., Mercer C. H., Erens B., Copas A. J., McManus S., Wellings K., Fenton K. A., Korovessis C., Macdowall W., Nanchahal K. Sexual behaviour in Britain: partnerships, practices, and HIV risk behaviours. Lancet. 2001 Dec 1;358(9296):1835–1842. doi: 10.1016/S0140-6736(01)06883-0. [DOI] [PubMed] [Google Scholar]
  15. Kherosheva T., Thorpe L. E., Kiryanova E., Rybka L., Gerasichev V., Shulgina M., Nemtsova E., Aptekar T., Kluge H., Jakubowiak W. Encouraging outcomes in the first year of a TB control demonstration program: Orel Oblast, Russia. Int J Tuberc Lung Dis. 2003 Nov;7(11):1045–1051. [PubMed] [Google Scholar]
  16. Kimerling M. E., Slavuckij A., Chavers S., Peremtin G. G., Tonkel T., Sirotkina O., Golubchikova V., Baddeley A. The risk of MDR-TB and polyresistant tuberculosis among the civilian population of Tomsk city, Siberia, 1999. Int J Tuberc Lung Dis. 2003 Sep;7(9):866–872. [PubMed] [Google Scholar]
  17. Nechaeva O. B., Skachkova E. I., Fomina N. I. Lekarstvennaia ustoichivost' mikobakterii tuberkuleza v Sverdlovskoi oblasti. Probl Tuberk. 2002;(9):8–11. [PubMed] [Google Scholar]
  18. Park M. M., Davis A. L., Schluger N. W., Cohen H., Rom W. N. Outcome of MDR-TB patients, 1983-1993. Prolonged survival with appropriate therapy. Am J Respir Crit Care Med. 1996 Jan;153(1):317–324. doi: 10.1164/ajrccm.153.1.8542137. [DOI] [PubMed] [Google Scholar]
  19. Quy H. T. W., Lan N. T. N., Borgdorff M. W., Grosset J., Linh P. D., Tung L. B., van Soolingen D., Raviglione M., Cô N. V., Broekmans J. Drug resistance among failure and relapse cases of tuberculosis: is the standard re-treatment regimen adequate? Int J Tuberc Lung Dis. 2003 Jul;7(7):631–636. [PubMed] [Google Scholar]
  20. Shilova M. V. Tuberkulez v Rossii v kontse XX veka. Probl Tuberk. 2001;(5):8–13. [PubMed] [Google Scholar]
  21. Smith S. L., Gugger M., Hoban P., Ratschiller D., Watson S. G., Field J. K., Betticher D. C., Heighway J. S100A2 is strongly expressed in airway basal cells, preneoplastic bronchial lesions and primary non-small cell lung carcinomas. Br J Cancer. 2004 Oct 18;91(8):1515–1524. doi: 10.1038/sj.bjc.6602188. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Spradling P., Drociuk D., McLaughlin S., Lee L. M., Peloquin C. A., Gallicano K., Pozsik C., Onorato I., Castro K. G., Ridzon R. Drug-drug interactions in inmates treated for human immunodeficiency virus and Mycobacterium tuberculosis infection or disease: an institutional tuberculosis outbreak. Clin Infect Dis. 2002 Oct 10;35(9):1106–1112. doi: 10.1086/343047. [DOI] [PubMed] [Google Scholar]
  23. Stern V. Problems in prisons worldwide, with a particular focus on Russia. Ann N Y Acad Sci. 2001 Dec;953:113–119. doi: 10.1111/j.1749-6632.2001.tb11367.x. [DOI] [PubMed] [Google Scholar]
  24. Suárez Pedro G., Floyd Katherine, Portocarrero Jaime, Alarcón Edith, Rapiti Elisabetta, Ramos Gilbert, Bonilla Cesar, Sabogal Ivan, Aranda Isabel, Dye Christopher. Feasibility and cost-effectiveness of standardised second-line drug treatment for chronic tuberculosis patients: a national cohort study in Peru. Lancet. 2002 Jun 8;359(9322):1980–1989. doi: 10.1016/S0140-6736(02)08830-X. [DOI] [PubMed] [Google Scholar]
  25. Toungoussova S., Caugant D. A., Sandven P., Mariandyshev A. O., Bjune G. Drug resistance of Mycobacterium tuberculosis strains isolated from patients with pulmonary tuberculosis in Archangels, Russia. Int J Tuberc Lung Dis. 2002 May;6(5):406–414. [PubMed] [Google Scholar]
  26. Vareldzis B. P., Grosset J., de Kantor I., Crofton J., Laszlo A., Felten M., Raviglione M. C., Kochi A. Drug-resistant tuberculosis: laboratory issues. World Health Organization recommendations. Tuber Lung Dis. 1994 Feb;75(1):1–7. doi: 10.1016/0962-8479(94)90096-5. [DOI] [PubMed] [Google Scholar]
  27. Viljanen M. K., Vyshnevskiy B. I., Otten T. F., Vyshnevskaya E., Marjamäki M., Soini H., Laippala P. J., Vasilyef A. V. Survey of drug-resistant tuberculosis in northwestern Russia from 1984 through 1994. Eur J Clin Microbiol Infect Dis. 1998 Mar;17(3):177–183. doi: 10.1007/BF01691114. [DOI] [PubMed] [Google Scholar]
  28. Yerokhin V. V., Punga V. V., Rybka L. N. Tuberculosis in Russia and the problem of multiple drug resistance. Ann N Y Acad Sci. 2001 Dec;953:133–137. doi: 10.1111/j.1749-6632.2001.tb11370.x. [DOI] [PubMed] [Google Scholar]

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