Mycobacterium tuberculosis Complex Drug Resistance in a High Tuberculosis Incidence Area from the WHO Eastern Mediterranean Region

Abstract

Purpose: The incidence of tuberculosis (TB) in Golestan province of Iran has been ranked 10th among countries of World Health Organization (WHO) Eastern Mediterranean Region. The province is residence of ethnically heterogeneous groups. However, there are limited data on Mycobacterium tuberculosis drug resistance in this province. The main aim of this study was to determine the resistance profile of M. tuberculosis complex (MTBC) isolates to first-line anti-TB drugs. Methods: The clinical specimens were collected from 11807 cases diagnosed during this study. MTBC isolates were tested for susceptibility to first-line anti-TB drugs. Results: A total of 176 new cases were diagnosed as culture positive for MTBC. There was one case that had multidrug-resistant (MDR) isolate and 18 (10.2%) had isolates that were resistant to at least one drug (any drug resistant). Resistance to streptomycin and isoniazid was noted in 15 (8.5%) and 5 isolates (2.8%), respectively. Also, a statistically significant association was observed between age groups and any drug resistance pattern (p = 0.022): 1-24 years vs. 25-45 years (p = 0.033), 25-45 years vs. >65 years (p = 0.010), 46-65 years vs. >65 years (p = 0.050). One third of any drug resistant isolates were obtained from TB patients of Persian ethnic group. Conclusion: Despite the high incidence of TB, the rate of MDR-TB in Golestan province was similar to those reported by WHO for Iranian new cases from other regions. One-tenth of the studied isolates showed any drug resistance pattern. This rate of any drug resistance implies the possibility of initial resistance of MTBC isolates circulating in this region.