Clinico-epidemiological profile and treatment outcome of drug-resistant tuberculosis patients admitted to drug-resistant-tuberculosis center in a tertiary care hospital in Varanasi

ABSTRACT

Background: Tuberculosis (TB) is one of the top ten causes of mortality and the leading cause of a single infectious agent. Unfortunately, India is home to approximately one-fourth of drug-resistant (DR)-TB cases globally. Despite all the developments in TB, the disease is becoming an important threat to public health. Objective: The present analysis was done to describe the profile and assess and compare the outcome of DR-TB patient admitted in DR-TB ward, Sir Sunderlal Hospital (SSH), Banaras Hindu University (BHU). Materials and Methods: Retrospective analysis of data from 2013 to 2018 of multi-DR (MDR)-TB patients admitted in DR-TB ward, SSH, Institute of Medical Sciences, BHU and treatment initiated after pre-treatment evaluation was conducted. Patients were referred from nearby nine districts of Uttar Pradesh. After pre-treatment evaluation treatment was initiated at DR-TB center, SSH as well as in their respective district. Results: A total of 3234 (76.7%) MDR-TB patients out of 4216 MDR-diagnosed patients were initiated on standard treatment which has increased from 74% in 2013. More than 93% of the cases were older than 15 years of age with slightly male predominance. The majority (>96%) of the cases were pulmonary TB. In the present analysis conversion of MDR-TB to extensively DR-TB (XDR-TB) was 7.7%. The treatment success rate for XDR-TB had also significantly improved from 11% in 2015 to 34% in 2017. Conclusion: Analysis shows 7.7% MDR patients converted into XDR; hence, there is a strong need to explore factors responsible for conversion. 7% of patients were <15 years of age indicating the need for separate pediatric DR-TB ward. 18% of DR-TB patients were defaulters; hence, the reason for it should be sought and addressed. Treatment success rate for MDR-TB has been seen improved from 40% in 2013 to 48% in 2017.