The prevalence and management of rifampicin-resistanct tuberculosis at Chris Hani Baragwanath Academic Hospital
Date
2017
Authors
Narsing, Rajiv Manhar
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Abstract
Background. Early effective management of drug-resistant tuberculosis (TB) is
important for the patient, and for infection control. The Xpert MTB/RIF (Cepheid, USA)
assay detects Mycobacterium tuberculosis DNA and the presence of rifampicin
resistance.
Objective. To assess the prevalence and initial management of rifampicin-resistant
pulmonary TB (PTB), confirmed by the Xpert MTB/RIF assay, in hospitalised adult
patients.
Methods. This retrospective descriptive study assessed adult patients from March 2011
to February 2013. Data was obtained from the National Health Laboratory Service
database and patient records. Management comprised the submission of additional
confirmatory sputum tests, initiation of appropriate anti-TB drug therapy, patient
isolation, and proper referral.
Results. The prevalence of rifampicin resistance was 10.6% (n=77) of 729 positive
assays. The initial management was assessed for the 70 patients with complete records.
However of these 70 patients, 12 patients had been discharged and 5 patients had died
prior to receiving their results. The management of the total cohort and of the 53
remaining inpatients were analysed separately. The overall confirmatory sputum
submission rates were 76%, 60%, 60% and 26% for TB microscopy, Line Probe Assay,
TB culture, and drug-susceptibility testing, respectively, and 87%, 72%, 68% and 30%,
VI
respectively for the 53 remaining patients. Overall, 33% of patients received appropriate
anti-TB treatment, 50% were isolated, and 49% were appropriately referred. For the 53
remaining patients, 43% received appropriate drug treatment, 66% were isolated, 64%
were appropriately referred, and 19% were not referred. The inpatient mortality rate was
19%.
Conclusions. Rifampicin-resistant TB prevalence in-hospital was more than double the
national rate. The initial management of patients with rifampicin-resistant PTB was
substandard. Submission of paired sputum samples and educating healthcare
professionals and healthcare users are of paramount importance to improve the
management of drug-resistant TB.
Description
A research report submitted to the Faculty of Health Sciences, University of the
Witwatersrand, in partial fulfilment of the requirements for the degree of
Master of Medicine in Internal Medicine, Johannesburg, 2017
Keywords
Rifampicin