Multidrug-Resistant Tuberculosis in Patients for Whom First-Line Treatment Failed, Mongolia, 2010–2011

Technical Appendix

Claudia C. Dobler

, Sarah Korver, Ochirbat Batbayar, Batiargal Nyamdulam, Sodnomdarjaa Oyuntsetseg, Bold Tsolmon, Bazarragchaa Surmaajav, Byambaa Bayarjargal, and Ben J. Marais

Author affiliations: Author affiliations: University of New South Wales, Sydney, New South Wales, Australia (C.C. Dobler); NHMRC Center of Research Excellence in Tuberculosis Control, University of Sydney, Sydney (C.C. Dobler, B.J. Marais); National Centre for Communicable Diseases, Ulaanbaatar, Mongolia (S. Korver, O. Batbayar, B. Nyamdulam, S. Oyuntsetseg, B. Tsolmon, B. Surmaajav, B. Bayarjargal); Marie Bashir Institute for Infectious Diseases and Biosecurity, Sydney (B.J. Marais)

Abstract

In Ulaanbaatar, Mongolia, multidrug-resistant tuberculosis (MDR TB) was diagnosed for more than a third of new sputum smear–positive tuberculosis patients for whom treatment had failed. This finding suggests a significant risk for community-acquired MDR TB and a need to make rapid molecular drug susceptibility testing available to more people.

In many resource-limited settings, the high cost and technical complexity of drug susceptibility testing (DST) preclude its routine use for patients in whom sputum smear–positive tuberculosis (TB) has been newly diagnosed. This lack of testing is particularly problematic in settings in which prevalence of multidrug-resistant (MDR) TB (resistant to at least isoniazid and rifampin) is high. Delayed diagnosis and inappropriate treatment prolong the patient’s interval of infectiousness and decrease the prospect of treatment success (1). Treating MDR TB with inappropriate drug regimens also increases the risk of amplifying drug resistance (2–5).

In Mongolia, failure of standard first-line TB treatment among patients with diagnosed MDR TB increased from 12% in 2006 to 38% in 2012 (Mongolian National TB Program [NTP], unpub. data; 6). During the same period, the proportion of new TB patients with MDR TB increased from 0% to 17%. Although these findings partly reflect the implementation of improved MDR TB case-finding strategies, they may also reflect increased MDR TB transmission within the community. In this study, we aimed to determine the prevalence of MDR TB among new sputum smear–positive patients for whom first-line treatment failed and to evaluate factors associated with an increased risk for MDR TB among these patients.

Dr. Dobler is a consultant pulmonologist at Liverpool Hospital, Sydney, Australia, and a National Health and Medical Research Council TRIP (translating research into practice) fellow at the Woolcock Institute of Medical Research in Sydney. She is interested in epidemiological and clinical research of respiratory diseases, especially tuberculosis.

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Tables

Technical Appendix

Technical Appendix. Phenotypic resistance to first-line drugs among multidrug-resistant tuberculosis patients for whom first-line treatment failed. 150 KB

Suggested citation for this article: Dobler CC, Korver S, Batbayar O, Nyamdulam B, Oyuntsetseg S, Tsolmon B, et al. Multidrug-resistant tuberculosis in patients for whom first-line treatment failed, Mongolia, 2010–2011. Emerg Infect Dis. 2015 Aug [date cited]. http://dx.doi.org/10.3201/ eid2108.141860

DOI: 10.3201/eid2108.141860