TITLE:
Clinical, Bacteriological Characteristics, and Outcomes of Primary Versus Secondary MDR/RR-TB Patients in Togo: A Retrospective Cohort Study
AUTHORS:
Adambounou Amento Stéphane, Ouattara Khadidia, Ako Akouvi Mawussi, Esseh-Yovo Marie Innocentia, Aziagbé Koffi Atsu, Gbadamassi Abdou Gafarou, Bocar Baya, Adjoh Komi Seraphin
KEYWORDS:
Drug-Resistant TB, Primary, Secondary, Togo
JOURNAL NAME:
Open Journal of Respiratory Diseases,
Vol.15 No.4,
October
31,
2025
ABSTRACT: Background and Objective: Anti-tuberculosis drug resistance is a worldwide health concern with a higher burden in resource-limited countries and vulnerable individuals. This study aimed to compare epidemiology, biological characteristics, and treatment outcomes of primary and secondary MDR/RR-TB patients in the Republic of Togo. Materials and Methods: A retrospective cohort study was conducted from January 2016 to December 2021 at the DR-TB unit at the Department of Pulmonology of Sylvanus Olympio Teaching Hospital in Togo. Data were collected from the medical records of TB patients hospitalized for rifampicin resistance based on the Xpert/MTB/RIF® results. A structured questionnaire was used to collect clinical, sociodemographic, biological, radiological, and patients’ outcomes data after the 9-month treatment regimen with the injectable TB drugs. Univariate and multivariate logistic regression analyses were performed to identify secondary MDR/RR associated factors. Results: A total of 89 patients, including 43 primary and 46 secondary MDR/RR-TB patient records, were enrolled in the final analysis. The sex ratio (male/female) was 1.3, and the mean age was 36.02 years. The secondary/acquired drug-resistant group was more likely to have dyspnea (aOR: 3.88, 95% CI: 1.01 - 14.38), nodules and infiltrates on chest-X-ray, respectively (aOR:3.62, 95% CI: 1.23 - 10.67) and (aOR: 4.66, 95% CI: 1.51 - 14.38). In addition, they were more likely to have a delay in MDR treatment initiation (aOR: 3.04, 95% CI: 1.08 - 8.58). Resistant to any first-line drugs was most found in the secondary drug-resistant group, while pre-XDR and XDR-TB were found in both groups. Conclusion: The secondary drug-resistant patients have the highest proportion of resistance patterns, including pre-XDR. Moreover, they are significantly associated with more lung lesions on chest X-ray. These results suggest a lack of treatment adherence and/or a high transmission rate of drug-resistant strains within the community. Hence, the importance of a non-pharmacological approach to improve adherence, contact tracking, and the improvement of laboratory capacities.