Prevalence of Pre-Extensively Drug-Resistant Tuberculosis (Pre XDR-TB) and Extensively Drug-Resistant Tuberculosis (XDR-TB) among Pulmonary Multidrug Resistant Tuberculosis (MDR-TB) at a Tertiary Care Center in Mumbai

Background: India is a high burden country for Tuberculosis (TB). As per the World Health Organization (WHO) statistics, 24000 cases of Multi Drug Resistant (MDR) TB were diagnosed in India in 2014. MDR-TB patients consist of a heterogeneous cohort and management has its challenges. Aims and objectives: We studied the prevalence of PreExtensively Drug Resistant TB (Pre XDR-TB) and Extensively Drug Resistant TB (XDR-TB) among patients of pulmonary MDR-TB not previously exposed to second-line anti-tuberculous drugs and having baseline second-line Drug Susceptibility Testing (DST) against Fluoroquinolones (FQ) and Aminoglycosides (AM). Results: We included 227 patients. On the basis of the DST, patients were grouped into1) MDR-TB, 2) MDR-TB with FQ resistance {Pre XDR-TB (FQ)}, 3) MDR-TB with AM resistance {Pre XDR-TB (AM)} 4) XDR-TB. Of the 227 patients, 89 (39.2%) had MDR-TB, 127 (55.94%) had Pre XDR-TB (FQ), none had Pre XDR-TB (AM) and 11 (4.86%) had XDR-TB. Nine (4%) patients were human immunodeficiency (HIV) infected and 25(11%) had Diabetes Mellitus (DM). Conclusion: This study highlights the importance of baseline DST to FQ and AM in patients of diagnosed or suspected MDR-TB. We encountered a higher prevalence of Pre XDR-TB (FQ) which of concern in management of MDR-TB.