Multidrug-resistant tuberculosis: Need for better diagnostic modalities and clinical end points – Five-year tertiary care hospital experience

Abstract Aims Multidrug-resistant tuberculosis (MDR-TB), a manmade disaster, is a threat to effective control of TB in resource-limited countries like India. The main aim was to study the resistance pattern of MDR-TB patients and their treatment outcome along with the drug-related adverse effects. Methods Patients who have completed treatment or expected to complete within the study period (2007–2012) diagnosed after January 2007 and on regular follow-up were screened. A total of 40 MDR-TB patients (28 pulmonary and 12 extra-pulmonary) were enrolled. All sputum specimens or other extra-pulmonary specimens were cultured using automated liquid culture system. Microbiological confirmation of tubercular bacteria was done using molecular identification system. Drug sensitivity testing of these patients was done using both genotypic and phenotypic methods. Results 63% were resistant to INH and rifampicin, 20% HRS and 17% to HRSE. 55% patients already received anti-tuberculosis treatment and failed treatment at enrolment. The primary outcomes were favourable in 97% (cure and treatment completion). No statistical significance was observed on comparing treatment outcome with drug resistance pattern, category of TB and type of TB. Major drug-related adverse effects seen were hypothyroidism and mild gastrointestinal symptoms. A total of 9 patients (22%) with MDR mediastinal lymphadenopathy could be identified with endobronchial ultrasound (EBUS)-guided fine needle aspiration (FNA) and treated with good outcome. Conclusion Most of the patients if properly treated and surgically intervened at the right time can have successful recovery. Use of new modality like EBUS-guided FNA in diagnosing extra-pulmonary MDR-TB appears promising.