First countrywide observational study of acquired drug resistance among TB cases in Ukraine

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Acquired drug resistance (ADR) to antituberculosis medicines is commonly neglected issue in high tuberculosis (TB) burden countries. We aimed to determine the prevalence of ADR and factors associated with its occurrence during TB treatment in Ukraine. Methods: We present results of retrospective population-based cohort study of all 50357 TB cases registered in the National TB database in 2014. ADR was defined as any change of drug susceptibility test (DST) result from susceptible at baseline to resistant at follow-up documented by the same method using minimum inhibitory concentration on Bactec or Löwenstein–Jensen medium. Clinical variables of TB patients and possible contributing factors of ADR have been analysed in SPSS. Results: Among 1688 TB cases with at least 2 DST results available using the same method, 513 (30.4%) had ADR. ADR mostly occurred within 4-5 months of hospitalisation. The highest rate of ADR was documented to quinolons – 47.8% (245/513) and second-line injectibles –40.0% (205/513). As a result of binomial logistic regression ADR were associated with new TB case OR 1.55 (95%CI 1.20-2.01) p=0.001 and region of living OR 8.10 (95%CI 1.02-64.21) p=0.048, while rural residence was associated with a reduction in the likelihood of acquisition of resistance OR -0.71 (95% CI 0.56-0.90) p=0.006. ADR negatively correlated with sputum culture conversion r=-0.069, p=0.005 and positively with culture reversion r=0.209, p<0.0005. Conclusions: ADR is a common phenomenon in Ukraine associated with delayed sputum culture conversion and high likelihood of poor infection control in some hospital settings.

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