Background Multidrug-resistant TB (MDR-TB, defined as resistance to at least isoniazid and rifampin) has emerged as a serious global public health problem, especially in former Soviet republics. The extent of the problem in Georgia has been incompletely defined because there have been no representative or population-based studies on the rates of drug-resistant TB in Georgia.
Purpose The purpose of this study was to determine the prevalence and risk factors for MDR-TB in the country of Georgia.
Methods/Study Design A prospective population-based study was carried out in the country of Georgia between July 2005 and May 2006. All patients diagnosed with AFB sputum smear positive (ss+) pulmonary TB in Georgia were enrolled and sputum specimens processed for culture, and subsequently, first-line drug susceptibility testing (DST) on one M. tuberculosis isolate recovered from each patient with a positive culture was performed. Specimens were collected from patients receiving care at 74 civilian TB facilities and 8 TB facilities within the penitentiary system located throughout Georgia. Demographic data, laboratory data, and data abstracted from medical records and patient interviews were entered into an Epi Info database and analyzed using SAS software (9.1).
Results A total of 2,200 ss+ patients were enrolled, and 1,451 were culture positive for M. tuberculosis. DST was available for 1,426 patients (98%). Overall, 810 (57%) patients had resistance to at least one anti-TB drug, and 220 (15%) of 1,426 patients had MDR-TB; 794 (56%) were newly diagnosed patients with TB, 511 (36%) were previously treated for TB for > 1 month, and prior treatment status was not known for 121 (8%) who were excluded from further analyses. In univariate analysis, patients who had previously been treated for TB were significantly more likely to have MDR-TB (140/511 [27%]) than patients who were newly diagnosed and never previously treated (53/794 [7%]) (OR = 5.27, 95% CI 3.75-7.41, p < .001). In multivariate analysis, previous TB treatment (OR = 5.71, 95% CI 4.00-8.15, p < .001) and female gender (OR = 1.60 95% CI 1.04-2.45, p = .03) were significantly associated with the presence of MDR-TB.
Conclusions Drug-resistant TB, including MDR-TB, has emerged as a major public health problem in Georgia. Further TB control efforts being implemented to prevent the development of new cases of MDR-TB and to treat existing patients with MDR-TB are urgently needed.
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