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Assessment of burden of drug-resistant tuberculosis at a tertiary care centre in northern India: a prospective single centre cohort study
Open accessAbstract
Objectives: We aim to define the burden of rifampicin monoresistant tuberculosis (TB) at a tertiary care centre in northern India as well as determine the second-line drug susceptibilities (SL-DST) in a subset of patients. Methods: A total of 3045 pulmonary (n=1883) and extrapulmonary (n=1162) samples from likely patients with TB were subjected to microscopy, culture and the Xpert MTB/RIF assay from March 2017 to June 2019. SL-DST testing by line probe assay version 2 for fluoroquinolones (FQs) and second-line injectable drugs were performed on 62 samples. Results: Out of 3045 samples processed in our laboratory during the study period, 36.1% (1101/3045) were positive for Mycobacterium tuberculosis complex (MTBC) and 21.6% were rifampicin monoresistant (223/1032). The rate of rifampicin resistance in pulmonary samples was 23.5% (166/706) and in extrapulmonary cases, it was 17.4% (57/326). Out of 62 cases included for second-line testing, 48 were resistant to FQs (77.4%) while 11 were extensively drug resistant. Conclusions: India urgently needs to arrest an emerging multidrug-resistant TB epidemic with associated resistance to FQs. A robust surveillance system is needed to execute the National Strategic Plan for 2017–2025.
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“the study found that the rate of rifampicin resistance among epTB cases was 4.83%, which is lower than the rate reported by previous studies conducted in India by Kant et al.,2018 (13.4%)15, Lohiya et al. 2020 (16%)16, and Misra et al. in 202117.”
From Prevalence of extrapulmonary tuberculosis and factors influencing successful treatment outcomes among notified cases in South India (2025) · cites this paper as [17]
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Short, Highly Effective, and Inexpensive Standardized Treatment of Multidrug-resistant Tuberculosis
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Prevalence and factors associated with multidrug-resistant tuberculosis in South India
Shivekar, S. S., Kaliaperumal, V., Brammacharry, U., Sakkaravarthy, A., Raj, C. K. V., Alagappan, C., & Muthaiah, M. (2020) · Scientific Reports · doi:10.1038/s41598-020-74432-y · Cited by 84
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Prevalence of drug-resistant pulmonary tuberculosis in India: systematic review and meta-analysis
Goyal, V., Kadam, V., Narang, P., & Singh, V. (2017) · BMC Public Health · doi:10.1186/s12889-017-4779-5 · Cited by 75
Drug-resistant tuberculosis: is India ready for the challenge?
Chatterjee, S., Poonawala, H., & Jain, Y. K. (2018) · BMJ Global Health · doi:10.1136/bmjgh-2018-000971 · Cited by 58
Law, S. J., Piatek, A. S., Vincent, C., Oxlade, O., & Menzies, D. (2016) · The Lancet Public Health · doi:10.1016/s2468-2667(16)30035-4 · Cited by 54
(2016) · Indian Journal of Tuberculosis · doi:10.1016/j.ijtb.2016.07.002 · Cited by 40
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Chee, C. B. E., KhinMar, K.-W., Sng, L.-H., Jureen, R., Cutter, J. L., Lee, V. J., & Wang, Y. T. (2017) · European Respiratory Journal · doi:10.1183/13993003.00753-2017 · Cited by 19
Limited Scope of Shorter Drug Regimen for MDR TB Caused by High Resistance to Fluoroquinolone
Singh, P. K., & Jain, A. (2019) · Emerging infectious diseases · doi:10.3201/eid2509.190105 · Cited by 16
Second-line Drug Resistance Characterization in Mycobacterium tuberculosis by Genotype MTBDRsl Assay
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Cited by
Tuberculosis challenges: Resistance, co-infection, diagnosis, and treatment
Heidary, M., Shirani, M., Moradi, M., Goudarzi, M., Pouriran, R., Rezaeian, T., & Khoshnood, S. (2022) · European Journal of Microbiology and Immunology · doi:10.1556/1886.2021.00021 · Cited by 76
Diriba, G., Alemu, A., Yenew, B., Tola, H. H., Gamtesa, D. F., Mollalign, H., Eshetu, K., Moga, S., Abdella, S., Tollera, G., et al. (2023) · International Journal of Infectious Diseases · doi:10.1016/j.ijid.2023.04.392 · Cited by 55
VidyaRaj, C. K., Vadakunnel, M. J., Mani, B. R., Anbazhagi, M., Pradhabane, G., Venkateswari, R., Palavesam, S., Venkatesh, K., Usharani, B., Sriramkumar, S. R., et al. (2025) · Scientific Reports · doi:10.1038/s41598-025-92613-5 · Cited by 31
“16 , and Misra et al. in 2021 17 .”
Gupta, A., Paliwal, V. K., Bharatveer, S., Mishra, P., & Jain, N. (2023) · American Journal of Tropical Medicine and Hygiene · doi:10.4269/ajtmh.23-0183 · Cited by 8
Insights into changing patterns of extrapulmonary tuberculosis in North India
Singhal, L., Gupta, P., Aysha, N., & Gupta, V. (2024) · Indian Journal of Medical Microbiology · doi:10.1016/j.ijmmb.2024.100657 · Cited by 8
Metadata
- Authors
- Misra, R., Kesarwani, V., & Nath, A.
- Affiliations
- Sanjay Gandhi Post Graduate Institute of Medical Sciences (IN)
- Corresponding author
- Nath, Alok
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2021-04
- Volume
- 11
- Issue
- 4
- Pages
- e044096
- ISSN
- 2044-6055 (ISSN-L)
- PMC
- PMC8055106
- OpenAlex
- W3155539427
- Cited by
- 14
- References
- 17
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 3 · 2023: 2 · 2022: 2
- FWCI
- 0.55
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMJ Open (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Tuberculosis Research and Epidemiology
- Health Sciences › Medicine › Infectious Diseases › Infectious Diseases and Tuberculosis
- Health Sciences › Medicine › Microbiology (medical) › Antibiotic Resistance in Bacteria
- Keywords
- drug-resistant tuberculosis, fluoroquinolone resistance, extensively drug-resistant tuberculosis, Mycobacterium tuberculosis complex, pulmonary tuberculosis, extrapulmonary tuberculosis, tuberculosis surveillance, North India
- MeSH terms
- Humans, India, Microbial Sensitivity Tests, Mycobacterium tuberculosis, Prospective Studies, Sensitivity and Specificity, Cohort Studies, Tuberculosis, Multidrug-Resistant, Drug Resistance, Bacterial, Tertiary Care Centers
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