Assessment of Antibiotic Resistance and Associated Factors in Patients with Tuberculosis: A Nationwide Cross-Sectional Study of Indonesian TB-DRS

ObjectiveIndonesia ranks second globally in terms of incidence of tuberculosis (TB), with a prevalence of 759 (95% CI: 589.7-960.8) cases per 100,000 people. Here, our cross-sectional population-based study (n=494) in Indonesia aims to reestablish the link between associated risk factors and antibiotic resistance. MethodData for this nationwide TB study was taken from the Tuberculosis Drug Resistance Survey (TB-DRS) by the Ministry of Health, Republic of Indonesia. The data was collected from a TB clinical field study conducted between 2017 and 2018. Participants provided demographic information through a self-report questionnaire after giving informed consent. Clinical samples were sent to our National Laboratory for testing the TB drug resistance status using MGIT960, GeneXpert, and Illumina-based WGS. Descriptive statistics were used to analyze the data with DATAtab software including Chi-square and other tests, and logistic regression. A significance level of p<0.05 was applied. ResultsTB resistance to drugs can be acquired irrespective of age-group ({chi}2=2.17, p=0.825), college education (OR: 1.1, 95% CI: 0.76-1.60, p=0.617, {chi}2=0.25), employment (OR: 0.93, 95% CI: 0.65-1.34, p=0.712, {chi}2=0.14), actively smoking (OR: 1.02, 95% CI: 0.61-1.69, p=0.951, {chi}2=0.00), geographical location ({chi}2=0.23, p=0.893), living community (OR: 0.94, 95% CI: 0.65-1.35, p=0.735, {chi}2=0.11), or previous attempts to seek treatment (OR: 1.26, 95% CI: 0.84-1.89, p=0.268, {chi}2=1.23). However, being female (OR: 1.6, 95% CI: 1.09-2.33, p=0.015, {chi}2=5.87), having a history of smoking (OR: 0.65, 95% CI: 0.45-0.94, p=0.021, {chi}2=5.36), and previously treated TB (OR: 0.02, 95% CI: 0.01-0.08, p<0.001, {chi}2=86.61) were linked to higher antibiotic resistance. ConclusionFocusing surveillance efforts on these statistically significant associated risk factors is crucial to halt the proliferation of drug-resistant TB within the population.