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Journal of global antimicrobial resistance
Feb 21, 2025;42 167-174.

Second-line drug resistance among multidrug-resistant tuberculosis patients in Ethiopia: A laboratory-based surveillance.

Getu Diriba, Ayinalem Alemu, Bazezew Yenew, Betselot Zerihun Ayano, Michael Hailu, Bedo Buta, Amanuel Wondimu, Zigba Tefera, Abyot Meaza, Getachew Seid, Muluwork Getahun, Biniyam Dagne, Hilina Mollalign, Yeshiwork Abebaw, Melak Getu, Mengistu Tadesse, Tegegn Belhu, Ephrem Alemu, Minilik Demissie, Ashenafi Erresso, Getachew Aga, Andargachew Kumsa, Taye Letta, Saro Abdella, Shewki Moga, Mesay Hailu Dangisso, Getachew Tollera, Gemechu Tadesse
Author Information
  1. Getu Diriba: Ethiopian Public Health Institute, Addis Ababa, Ethiopia. Electronic address: getud2020@gmail.com.
  2. Ayinalem Alemu: Ethiopian Public Health Institute, Addis Ababa, Ethiopia; Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia.
  3. Bazezew Yenew: Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
  4. Betselot Zerihun Ayano: Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
  5. Michael Hailu: Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
  6. Bedo Buta: Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
  7. Amanuel Wondimu: Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
  8. Zigba Tefera: Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
  9. Abyot Meaza: Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
  10. Getachew Seid: Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
  11. Muluwork Getahun: Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
  12. Biniyam Dagne: Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
  13. Hilina Mollalign: Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
  14. Yeshiwork Abebaw: Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
  15. Melak Getu: Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
  16. Mengistu Tadesse: Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
  17. Tegegn Belhu: Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
  18. Ephrem Alemu: Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
  19. Minilik Demissie: Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
  20. Ashenafi Erresso: Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
  21. Getachew Aga: Ministry of Health, National TB, Leprosy and other Lung Diseases Control Program, Addis Ababa, Ethiopia.
  22. Andargachew Kumsa: Ministry of Health, National TB, Leprosy and other Lung Diseases Control Program, Addis Ababa, Ethiopia.
  23. Taye Letta: Ministry of Health, National TB, Leprosy and other Lung Diseases Control Program, Addis Ababa, Ethiopia.
  24. Saro Abdella: Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
  25. Shewki Moga: Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
  26. Mesay Hailu Dangisso: Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
  27. Getachew Tollera: Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
  28. Gemechu Tadesse: Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
PMID: 39988072 DOI: 10.1016/j.jgar.2025.02.014

Abstract

OBJECTIVES: To estimate the proportion of second-line anti-tuberculosis drug resistance among multidrug-resistant tuberculosis (MDR-TB) patients in Ethiopia.
METHODOLOGY: A laboratory-based prospective cross-sectional study was conducted at the National Tuberculosis Reference Laboratory (NTRL), Ethiopia, from February 2022 to July 2024. Phenotypic drug susceptibility testing (pDST) assessed resistance to various second-line antituberculosis drugs. The collected data were entered into Microsoft Excel 2016 and imported into Statistical Package for Social Sciences (SPSS) version 23 for descriptive analysis.
RESULT: Of 468 MDR-TB patients, 262 were new, and 206 were previously treated cases. Pre-extensively drug-resistant tuberculosis (pre-XDR-TB) was identified in four (1.52%) new cases and seven (3.40%) previously treated cases. Extensively drug-resistant tuberculosis (XDR-TB) was detected in three (1.15%) new cases and two (0.97%) previously treated cases. Overall, 11 (2.35%) cases were classified as pre-XDR-TB, and five (1.07%) as XDR-TB. Combined resistance to fluoroquinolones (FQs) and bedaquiline were detected in four cases (0.85%), comprising three new cases (1.15%) and one previously treated case (0.49%). Resistance to both FQs and linezolid was detected in a single previously treated case (0.49%) and acquired resistance to second-line drugs was identified in four cases.
CONCLUSIONS: Our study showed a prevalence of 2.35% for pre-XDR-TB and 1.07% for XDR-TB among MDR-TB cases, highlighting the importance of continuous surveillance and tailored treatment approaches to control the spread of drug-resistant TB (DR-TB) in Ethiopia. Future studies on MDR-TB surveillance should prioritize the integration of genomic surveillance into routine laboratory-based DR-TB monitoring systems to enhance early detection of resistance patterns, support targeted treatment strategies, and improve overall patient management efforts.

Keywords

Extensively drug-resistant tuberculosis Multidrug-resistant tuberculosis Pre-extensively drug-resistant
Journal Article

Word Cloud

Created with Highcharts 10.0.0casesresistancetuberculosispreviouslytreateddrug-resistant1MDR-TBnew0surveillancesecond-linedrugamongpatientsEthiopialaboratory-basedpre-XDR-TBfourXDR-TBdetectedmultidrug-resistantstudydrugsPre-extensivelyidentifiedExtensivelythree15%235%07%FQscase49%treatmentDR-TBOBJECTIVES:estimateproportionanti-tuberculosisMETHODOLOGY:prospectivecross-sectionalconductedNationalTuberculosisReferenceLaboratoryNTRLFebruary2022July2024PhenotypicsusceptibilitytestingpDSTassessedvariousantituberculosiscollecteddataenteredMicrosoftExcel2016importedStatisticalPackageSocialSciencesSPSSversion23descriptiveanalysisRESULT:46826220652%seven340%two97%Overall11classifiedfiveCombinedfluoroquinolonesbedaquiline85%comprisingoneResistancelinezolidsingleacquiredCONCLUSIONS:showedprevalencehighlightingimportancecontinuoustailoredapproachescontrolspreadTBFuturestudiesprioritizeintegrationgenomicroutinemonitoringsystemsenhanceearlydetectionpatternssupporttargetedstrategiesimproveoverallpatientmanagementeffortsSecond-lineEthiopia:Multidrug-resistant

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