Mycobacteria Presence and Anti-Tuberculosis Drug Resistance Profile in Düzce Region: 18 Years of Experience

Year 2025, Issue: Early Access

Emel Akbaş , Banu Hümeyra Keskin , Emel Çalışkan , Şükrü Öksüz , İdris Şahin , Cihadiye Elif Öztürk

https://doi.org/10.18678/dtfd.1564849

Abstract

Aim: The aim of this study was to determine the frequency of Mycobacterium tuberculosis complex (MTBC) and non-tuberculous mycobacteria (NTM) growth among mycobacterial isolates collected over 18 years from patients suspected of having tuberculosis, and to evaluate the resistance rates of MTBC strains to first-line anti-tuberculosis drugs.
Material and Methods: A total of 17,199 clinical specimens, sent to the Mycobacteriology Laboratory, Department of Medical Microbiology, at Düzce University Health Application and Research Centre between 2004 and 2021 for suspected tuberculosis, were retrospectively analyzed in this study. To differentiate MTBC from NTM, the TBC Identification Test was performed to detect the MPT64 antigen of the MTBC. Ehrlich-Ziehl-Neelsen (EZN) staining method was used to detect the presence of acid-fast bacilli (AFB).
Results: Out of the samples with suspected tuberculosis, mycobacterial growth was detected in 896 (5.2%) cases. Among these, 824 (91.9%) were identified as MTBC, while 72 (8.1%) were classified as NTM. EZN staining revealed that 404 (45.1%) out of the 896 isolates were found AFB positive. Analysis of first-line anti-tuberculosis drug susceptibility in the 824 MTBC isolates revealed that 194 were resistant to at least one first-line anti-tuberculosis drug. Of these, 135 isolates showed resistance to a single drug, while 59 exhibited resistance to more than one drug.
Conclusion: Tuberculosis remains a significant public health problem both globally and in Türkiye. Regular investigation of local and regional growth patterns and resistance profiles is crucial for achieving the goals of tuberculosis elimination and eradication.

Keywords

Tuberculosis, non-tuberculous mycobacteria, anti-tuberculosis drug resistance

Düzce Bölgesinde Mikobakteri Varlığı ve Antitüberküloz İlaç Direnci Profili: 18 Yıllık Deneyim

Abstract

Amaç: Bu çalışmanın amacı, tüberküloz şüphesi olan hastalardan 18 yıl boyunca toplanan mikobakteri izolatlarında Mycobacterium tuberculosis kompleks (MTBK) ve tüberküloz dışı mikobakteri (TDM) üreme sıklığını belirlemek ve MTBK olarak izole edilen suşların birinci basamak anti-tüberküloz ilaçlara direnç oranlarını değerlendirmektir.
Gereç ve Yöntemler: Bu çalışmada, Düzce Üniversitesi Sağlık Uygulama ve Araştırma Merkezi Tıbbi Mikrobiyoloji Anabilim Dalı Mikobakteriyoloji Laboratuvarı'na 2004 ve 2021 yılları arasında tüberküloz şüphesi ile gönderilen toplam 17.199 klinik örnek geriye dönük olarak analiz edildi. MTBK'yi TDM'den ayırt etmek için, MTBK'nin MPT64 antijenini tespit etmek amacıyla TBC Tanımlama Testi yapıldı. Asit-dirençli basillerin (ARB) varlığını tespit etmek amacıyla Ehrlich-Ziehl-Neelsen (EZN) boyama yöntemi kullanıldı.
Bulgular: Tüberküloz şüphesi ile gönderilen örneklerden 896 (%5,2) vakada mikobakteri üremesi tespit edildi. Bunlardan 824'ü (%91,9) MTBK olarak tanımlanırken 72'si (%8,1) TDM olarak sınıflandırıldı. EZN boyama sonucunda 896 izolatın 404'ünde (%45,1) ARB pozitifliği saptandı. 824 MTBK izolatında birinci basamak anti-tüberküloz ilaç duyarlılığının analizi, 194'ünün en az bir birinci basamak anti-tüberküloz ilaca dirençli olduğunu ortaya koydu. Bunlardan 135 izolat tek bir ilaca direnç gösterirken, 59'u birden fazla ilaca direnç göstermekteydi.
Sonuç: Tüberküloz, hem küresel olarak hem de Türkiye'de önemli bir halk sağlığı sorunu olmaya devam etmektedir. Tüberkülozun ortadan kaldırılması ve yok edilmesi hedeflerine ulaşmak için yerel ve bölgesel üreme kalıplarının ve direnç profillerinin düzenli olarak araştırılması hayati önem taşımaktadır.

Keywords

Tüberküloz, atipik mikobakteri, anti-tüberküloz ilaç direnci

References

• Kanabalan RD, Lee LJ, Lee TY, Chong PP, Hassan L, Ismail R, et al. Human tuberculosis and mycobacterium tuberculosis complex: A review on genetic diversity, pathogenesis and omics approaches in host biomarkers discovery. Microbiol Res. 2021;246:126674.
• Waters V, Ratjen F. Antibiotic treatment for nontuberculous mycobacteria lung infection in people with cystic fibrosis. Cochrane Database Syst Rev. 2020;6(6):CD010004.
• Gopalaswamy R, Shanmugam S, Mondal R, Subbian S. Of tuberculosis and non-tuberculous mycobacterial infections - a comparative analysis of epidemiology, diagnosis and treatment. J Biomed Sci. 2020;27(1):74.
• World Health Organization. Global tuberculosis report 2021. Geneva: World Health Organization; 2021.
• Özen N, Kula Atik T, Çetin Duran A. Evaluation of mycobacterium tuberculosis culture and drug susceptibility test results and the distribution of nontuberculosis mycobacteria from the clinical specimens. Mikrobiyol Bul. 2020;54(4):559-74. Turkish.
• T.C. Sağlık Bakanlığı. Ulusal Tüberküloz Tanı Rehberi. Türkiye Halk Sağlığı Kurumu, Sağlık Bakanlığı Yayın No: 935. Ankara; 2014. Turkish.
• T.C. Sağlık Bakanlığı. Türkiye’de Verem Savaşı 2021 Raporu. Halk Sağlığı Genel Müdürlüğü, Sağlık Bakanlığı Yayın No: 1274. Ankara; 2023. Turkish.
• Kirui JK, Nyamache AK, Maingi JM, Ogari C. Prevalence of multidrug resistant tuberculosis among previously treated TB patients in Nairobi county, Kenya. Int Clin Med Therp. 2019;1(1):4.
• Yazısız H, Hırçın Cenger D, Yazısız V, Kılıç L, Altın S. First-line anti-tuberculosis drug resistance trends of mycobacterium tuberculosis complex isolates. A tertiary hospital study in Turkey. Tuberk Toraks. 2019;67(2):92-101.
• Kivihya-Ndugga LE, van Cleeff MR, Githui WA, Nganga LW, Kibuga DK, Odhiambo JA, et al. A comprehensive comparison of Ziehl-Neelsen and fluorescence microscopy for the diagnosis of tuberculosis in a resource-poor urban setting. Int J Tuberc Lung Dis. 2003;7(12):1163-71.
• Yıldıran ST, Özyurt M, Saraçlı MA, Gün H. The evaluation of the smear and culture results of mycobacteriological specimens in a seven-year study period: A retrospective study. İnfeksiyon Derg. 1998;12(2):151-5. Turkish.
• Tarhan G, Ordulu L, Gümüşlü F, Ceyhan I, Cesur S. Comparison of auramine-rhodamine and Erlich-Ziehl-Neelsen staining methods for the diagnosis of tuberculosis. Mikrobiyol Bul. 2003;37(2-3):131-6. Turkish.
• Arora J, Singhal R, Verma AK, Kumar G, Bhalla M, Sarin R, et al. Isoniazid resistance among rifampicin-susceptible mycobacterium tuberculosis isolates from tuberculosis patients. Int J Mycobacteriol. 2016;5(Suppl 1):S127-8.
• He XC, Zhang XX, Zhao JN, Liu Y, Yu CB, Yang GR, et al. Epidemiological trends of drug-resistant tuberculosis in China from 2007 to 2014: A retrospective study. Medicine (Baltimore). 2016;95(15):e3336.
• Yılmaz A, Afşin D. Investigation of the sensitivity of mycobacterium tuberculosis strains isolated from various clinical samples in eastern Turkey to major anti-tuberculosis drugs. J Contemp Med. 2021;11(1):92-6.
• Molla KA, Reta MA, Ayene YY. Prevalence of multidrug-resistant tuberculosis in East Africa: A systematic review and meta-analysis. PLoS One. 2022;17(6):e0270272.
• Liu H, Lian L, Jiang Y, Huang M, Tan Y, Zhao X, et al. Identification of species of nontuberculous mycobacteria clinical isolates from 8 provinces of China. Biomed Res Int. 2016;2016:2153910.
• Martínez González S, Cano Cortés A, Sota Yoldi LA, García García JM, Alba Álvarez LM, Palacios Gutiérrez JJ. Non-tuberculous mycobacteria. An emerging threat? Arch Bronconeumol. 2017;53(10):554-60.
• Daley CL, Iaccarino JM, Lange C, Cambau E, Wallace RJ Jr, Andrejak C, et al. Treatment of nontuberculous mycobacterial pulmonary disease: An official ATS/ERS/ESCMID/IDSA clinical practice guideline. Eur Respir J. 2020;56(1):2000535.