ABSTRACT
Objective: To determine the current sensitivity pattern of second line anti-tuberculosis drugs against clinical isolates of Multidrug Resistant Mycobacterium tuberculosis [MDR-TB]. Study Design: A cross-sectional study. Place and Duration of Study: Department of Microbiology, Armed Forces Institute of Pathology [AFIP], Rawalpindi, from November 2011 to April 2013. Methodology: Samples received during the study period were processed on BACTEC MGIT 960 system for Mycobacterium tuberculosis [MTB] culture followed by first line drugs susceptibility testing of culture proven MTB isolates. On the basis of resistance to rifampicin and isoniazid, 100 clinical isolates of MDR-TB were further subjected to susceptibility testing against amikacin [AMK], capreomycin [CAP], ofloxacin [OFL] and ethionamide [ETH] as per st and ard BACTEC MGIT 960 instructions. Results: Out of 100 MDR-TB isolates, 62% were from male patients and 38% from female patients. 97% were sensitive to AMK, 53% to OFL, 87% to CAP; and 87% were sensitive to ETH. Conclusion: The majority of the MDR-TB isolates showed excellent sensitivity against AMK, CAP and ETH. However, sensitivity of MDR-TB isolates against fluoroquinolones like OFL was not encouraging. Key Words: Multidrug resistant tuberculosis. Mycobacteria growth indicator tube. Second line anti-tuberculosis drugs. Amikacin. Capreomycin. Ethionamide
ABSTRACT
The present meta-analysis aims to assess the evidence regarding the diagnostic accuracy and performance characteristics of the colorimetric redox indicator [CRI] assay with a special emphasis on the use of the resazurin microtiter assay [REMA] for determination of primary anti-tuberculosis drug resistance. By updating previous literature searches in Medline PubMed, ISI Web, Web of Science and Google academic databases of the REMA test for determination of primary anti-tuberculosis drug resistance, this meta-analysis includes 14 studies for isoniazid [INH]; 15 studies for rifampicin [RIF]; 6 studies for streptomycin [STR]; and 5 studies for ethambutol [EMB]. SROC curve analysis was performed for meta-analysis and diagnostic accuracy was summarized.: Pooled sensitivity was 96% [94-98%] for INH, 97% [95-98%] for RIF, 92% [87-96%] for EMB and 92% [88-95%] for STR. Pooled specificity for INH, RIF, EMB and STR was 96% [95-98%], 99% [98-99%], 86% [81-89%] and 90% [87-93%], respectively. Susceptibility testing results had been obtained in 8-9 days. In conclusion, REMA seems to be a reliable test for the determination of multidrug resistant [MDR] isolates in laboratories with limited resources. However, few studies for STR and EMB have been found, and costeffectiveness studies need to be determined to recommend its widespread use