Evaluation of Multi-Drug Resistant Tuberculosis Predictor Index in Surakarta, Central Java

Putri Pamungkas, Setyo Sri Rahardjo, Bhisma Murti


Background: Tuberculosis (TB) remains a global public health problem. New cases of lung Tuberculosis in 2015 were 10.4 million worldwide. One of the challenging in TB control to be addressed is the development of Multi-Drug Resistant Tuberculosis (MDR-TB). There were an estimated 15,380 TB cases in Indonesia by 2015 with 1,860 positive TB cases and 1,566 cases successfully treated. This study aimed to determine the predictor index for MDR-TB.

Subjects and Method: This was an analytic observational study with a case-control design. The study was conducted at Dr. Moewardi Hospital, Surakarta, Central Java, from August to November 2017. The study subjects were selected by fixed disease sampling including 75 MDR-TB patients and 75 TB patients. The dependent variable was MDR-TB. The independent variables were medical history, co-morbidity (Diabetes Mellitus), drug side effect, drug-taking supervisor, and regularity of treatment. The data were collected by questionnaire and medical record. The data were analyzed by a multiple logistic regression.

Results: MDR-TB Occurrence Index increased with drug-taking supervisor (b = 2.33; 95% CI= 3.83 to 27.91; p<0.001), drug-side effect (b = 0.73; 95% CI= 0.58 to 7.45; p=0.026), medical history (b = 2.35; 95% CI= 3.80 to 29.38; p<0.001). MDR-TB Occurrence Index decreased by absence of type 2 Diabetes Mellitus (b = -0.56; 95% CI= 0.18 to 1.78; p= 0.033), regular treatment (b = -1.73; 95% CI= 0.06 to 0.46; p<0.001).

Conclusion: MDR-TB Occurrence Index is determined by the drug-taking supervisor, drug side effect, medical history, Type 2 Diabetes Mellitus, and regular treatment.

Keywords: MDR-TB Occurrence Index, medical history, drug-taking supervisor, drug side effect, Type 2 Diabetes Mellitus, regular treatment

Correspondence: Putri Pamungkas. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami No. 36 A, 57126, Surakarta, Central Java. Email: pamungkasputri95@gmail.com.

Journal of Epidemiology and Public Health (2018), 3(2): 263-276


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Abouyannis M. et al. (2014). Drug resistance of Mycobacterium tuberculosis in Malawi: a crosssectional survey’, 798–806.

Arockiaraj, J. et al. (2018) ‘Drug-resistant Skeletal Tuberculosis in a tertiary care center in South India’, Journal of Clinical Orthopaedics and Trauma. Operating Company Elsevier B.V., (2017). doi: 10.1016/j.jcot.2017.12.009.

Bradley, P. et al. (2015) ‘Rapid antibioticresistance predictions from genome sequence data for Staphylococcus aureus and Mycobacterium tuberculosis’, Nature Communications. Nature Publishing Group, 6: 1–14. doi: 10.1038/ncomms10063.

Denkinger CM, Pai M, Dowdy DW (2014) ‘Do we need to detect isoniazid resistance in addition to rifampicin resistance in diagnostic tests for tuberculosis?’, PLoS ONE, 9(1). doi: 10.1371/journal.pone.0084197.

Efsen AMW. et al. (2018) ‘Management of MDR-TB in HIV coinfected patients in Eastern Europe: Results from the TB:HIV study’, Journal of Infection, 76(1): 44–54. doi: 10.1016/j.jinf.2017.10.007.

Fox GJ. et al. (2017) ‘Preventive therapy for latent tuberculosis infectionthe promise and the challenges’, International Journal of Infectious Diseases. International Society for Infectious Diseases, 56, pp. 68–76. doi: 10.1016/j.ijid.2016.11.006.

Ginandjar P, Saraswati LD, Widjanarko, B. (2016). Profile of glycatedhemoglobin, antioxidant vitamin and cytokine levels in pulmonary tuberculosis patients: A cross sectional study at Pulmonary Diseases Center Semarang City, Indonesia’, Biomedical Journal. Elsevier Ltd, 39(5): 354–360. doi: 10.1016/j.bj.2016.01.011.

Jia, Z. et al. (2014) ‘Tuberculosis burden in China: A high prevalence of pulmonary tuberculosis in household contacts with and without symptoms’, BMC Infectious Diseases. BMC Infectious Diseases, 14(1), pp. 1–7. doi: 10.1186/147123341464.

Kigozi, G. et al. (2017) ‘Factors influencing treatment default among tuberculosis patients in a high burden province of South Africa’, International Journal of Infectious Diseases. The Author(s), 54: 95–102. doi: 10.1016/j.ijid.2016.11.407.

Lee, S. J. et al. (2014) ‘Risk factors for latent tuberculosis infection in close contacts of active tuberculosis patients in South Korea: A prospective cohort study’, BMC Infectious Diseases, 14(1): 1–7. doi: 10.1186/s1287901405664.

Lin CY. et al. (2016) ‘Risk factors of multidrugresistant Acinetobacter baumannii recurrence after successful eradication in ventilated patients’, Biomedical Journal. Elsevier Ltd, 39(2): 130–138. doi: 10.1016/j.bj.2015.07.001.

Liu X. et al. (2015) ‘Effectiveness of Electronic Reminders to Improve Medication Adherence in Tuberculosis Patients: A Cluster Randomised Trial’, PLoS Medicine, 12(9): 1–19. doi: 10.1371/journal.pmed.1001876.

Matteelli A. et al. (2017) ‘Tuberculosis elimination and the challenge of latent tuberculosis’, Presse Medicale. Elsevier Masson SAS, 46(2): e13–e21. doi: 10.1016/j.lpm.2017.01.015.

McBryde, E. S. et al. (2017) ‘The risk of global epidemic replacement with drugresistant Mycobacterium tuberculosis strains’, International Journal of Infectious Diseases. International Society for Infectious Diseases, 56, pp. 14–20. doi: 10.1016/j.ijid.2017.01.031.

McClintock, A. H. et al. (2017) ‘Treatment completion for latent tuberculosis infection: a retrospective cohort study comparing 9 months of isoniazid, 4 months of rifampin and 3 months of isoniazid and rifapentine’, BMC Infectious Diseases. BMC Infectious Diseases, 17(1): 146. doi: 10.1186/s1287901722458.

Mohd N, Azhar S, KamaludinF (2015) ‘and suburban living: The risk factors of multidrug resistant tuberculosis among Malaysians’, International Journal of Mycobacteriology. Asian African Society for Mycobacteriology, 5(1): 51–58. doi: 10.1016/j.ijmyco.2015.11.001.

Nagu, T. J. et al. (2015) ‘Multi drug and other forms of drug resistant tuberculosis are uncommon among treatment naïve tuberculosis patients in Tanzania’, PLoS ONE, 10(4), pp. 1–11. doi: 10.1371/journal.pone.0118601.

Outhred AC, Britton PN, Marais BJ (2017) ‘Drugresistant tuberculosis – primary transmission and management’, Journal of Infection. Elsevier Ltd, 74, pp. S128–S135. doi: 10.1016/S01634453(17)302037.

Pinto CMA, Carvalho ARM (2017). The HIV/TB coinfection severity in the presence of TB multidrug resistant strains, Ecological Complexity. Elsevier BV, 32: 1–20. doi: 10.1016/j.ecocom.2017.08.001.

Suwanpimolkul, G. et al. (2017) ‘Utility of urine lipoarabinomannan (LAM) in diagnosing tuberculosis and predicting mortality with and without HIV: prospective TB cohort from the Thailand Big City TB Research Network’, International Journal of Infectious Diseases. International Society for Infectious Diseases, 59: 96–102. doi: 10.1016/j.ijid.2017.04.017.

Tola H. H. et al. (2016) ‘Psychological and educational intervention to improve tuberculosis treatment adherence in Ethiopia based on health belief model: A cluster randomized control trial’, PLoS ONE, 11(5), pp. 1–16. doi: 10.1371/journal.pone.0155147.

WHO (2013) MultidrugResistant Tuberculosis (MDR TB): 2013 Update’, Online, (March). Available at: http://www.who.int/tb/challenges/mdr/MDR_TB_FactSheet.pdf.

Yates TA. et al. (2016) ‘The transmission of Mycobacterium tuberculosis in high burden settings’, The Lancet Infectious Diseases. Elsevier Ltd, 16(2), pp. 227–238. doi: 10.1016/S14733099 (15): 004995.

Drug Resistance Survey (DRS). 2016. Multiple Drugs Resistant Tuberculosis survey. Kemenkes RI. www.tbindonesia.or.id/tbmdr (aksess: 21 April 2017).

Infodatin (2015). Tuberkulosis. Jakarta: Pusat data dan informasi Kementerian Kesehatan RI, 2015. ISSN 2442-7659.

Bello SI, Itiola (2010) Drug Adherence amongst Tuberculosis Patient in the University of Ilorin Teaching Hospital, Ilorin, Nigeria. African Journal of Pharmacy and Pharmacology, 4(3).

Mediana (2002). Faktor yang Berhubungan dengan Terjadinya DO PADA Penderita TB Paru di Kabupaten Bandung Tahun 2001, Tesis, Universitas Indonesia, Jakarta.

Bashar M, Alchabes P, Rom W, Condos R (2001). Increase Incidence of MultidrugResistant Tuberculosis in Diabetic Patients on the Bellevue Chest Service. Chest. 120(5).


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