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Characteristics of Drug-sensitive and Drug-resistant Tuberculosis Cases among Adults at Tuberculosis Referral Hospitals in Indonesia

Erlina BurhanPersahabatan Hospital/Department of Pulmonary and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia;

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Muhammad KaryanaNational Institute of Health Research and Development, Ministry of Health, Republic of Indonesia, Jakarta, Indonesia;

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Anis KaruniawatiDepartment of Microbiology, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia;

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Tutik KusmiatiDr. Soetomo Hospital/Universitas Airlangga, Surabaya, Indonesia;

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Banteng Hanang WibisonoDr. Kariadi Hospital/Universitas Diponegoro, Semarang, Indonesia;

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Diah HandayaniPersahabatan Hospital/Department of Pulmonary and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia;

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Bambang Sigit RiyantoDr. Sardjito Hospital/Universitas Gadjah Mada, Yogyakarta, Indonesia;

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I Gede Ketut SajinadiyasaSanglah General Hospital, Bali, Indonesia;

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Bintang Yinke Magdalena SinagaH. Adam Malik General Hospital, Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia;

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Irawaty DjaharuddinDr. Wahidin Sudirohusodo Hospital/Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, University of Hasanuddin, Makassar, Indonesia;

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Retna Indah SugiyonoIndonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia;

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Nugroho Harry SusantoIndonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia;

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Aly DianaIndonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia;
Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Sumedang, Indonesia;

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Herman KosasihIndonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia;

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Dewi LokidaDepartment of Clinical Pathology, Tangerang District Hospital, Tangerang, Indonesia;

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SiswantoNational Institute of Health Research and Development, Ministry of Health, Republic of Indonesia, Jakarta, Indonesia;

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Aaron NealNational Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland;

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Chuen-Yen LauHIV Dynamics and Replication Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland

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Sophia SiddiquiNational Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland;

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ABSTRACT.

As Indonesia’s rifampin resistance testing rates are lower than global testing rates per the 2020 WHO global tuberculosis (TB) report, prevalence of multidrug-resistant TB may be underestimated. Our study aimed to evaluate prevalence and patterns of TB drug resistance (DR) within Indonesia. We conducted a cross-sectional analysis of baseline data collected from 2017–2018 as part of a cohort study of adults with presumed pulmonary TB at 7 DR-TB referral hospitals in Indonesia. Bacteriological examinations (acid-fast bacilli, GeneXpert, sputum culture) and drug-susceptibility testing were performed following the guidelines of the National TB Program. Of 447 participants with complete bacteriological examinations, 312 (69.8%) had positive sputum cultures for Mycobacterium tuberculosis. The proportion of MDR and pre-extensively drug-resistant was higher in previously treated compared with newly diagnosed participants (52.5% [73/139] versus 15% [26/173]). Compared with drug-sensitive case, drug-resistant TB was associated with cavities. Given the difference between rates of DR in TB referral hospitals from our study compared with the WHO survey in 2019 that showed 17.7% and 3.3% DR among previously treated and newly diagnosed participants globally, further characterization of Indonesia’s TB epidemiology in the general population is needed. Strategies, including public policies to optimize case finding, strengthen capacity for resistance testing, and prevent loss to follow-up will be critical to reduce the burden of TB in Indonesia.

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Author Notes

Address correspondence to Herman Kosasih, Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Jalan Percetakan Negara No. 29, Jakarta 10560, Indonesia. E-mail: hkosasih@ina-respond.net

Financial support: This work has been funded in whole or in part with Ministry of Health Indonesia; the Intramural Research Program, National Institutes of Health; National Cancer Institute, Center for Cancer Research, National Institutes of Health; and federal funds from the National Institute of Allergy and Infectious Diseases, National Institutes of Health, under contract nos. HHSN261200800001E and HHSN261201500003I. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. government.

Authors’ addresses: Erlina Burhan and Diah Handayani, Persahabatan Hospital/Department of Pulmonary and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta Pusat, Indonesia, E-mails: erlina_burhan@yahoo.com and diahzulfitri@yahoo.com. Muhammad Karyana and Siswanto Siswanto, National Institute of Health Research and Development, Jakarta, Indonesia, E-mails: mkaryana@ina-respond.net and siswantos@yahoo.com. Anis Karuniawati, Department of Microbiology, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta Pusat, Indonesia, E-mail: anis.karuniawatimk@ui.ac.id. Tutik Kusmiati, Dr. Soetomo Hospital/Universitas Airlangga, Surabaya, Indonesia, E-mail: tutik.kusmiati93@gmail.com. Banteng Hanang Wibisono, Dr. Kariadi Hospital/Universitas Diponegoro, Semarang, Indonesia, E-mail: bantenghw@gmail.com. Bambang Sigit Riyanto, Dr. Sardjito Hospital/Universitas Gadjah Mada, Yogyakarta 55281, Indonesia, E-mail: bambangsigit_r@yahoo.com. I Gede Ketut Sajinadiyasa, Sanglah General Hospital, Bali, Indonesia, E-mail: sajinadiyasa@yahoo.com. Bintang Yinke Magdalena Sinaga, H. Adam Malik General Hospital, Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia, E-mail: bmysinaga@yahoo.co.id. Irawaty Djaharuddin, Dr. Wahidin Sudirohusodo Hospital/Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, University of Hasanuddin, Makassar, Indonesia, E-mail: irawatymuzakkir@gmail.com. Retna Indah Sugiyono, Nugroho Harry Susanto, and Herman Kosasih, Indonesia Research Partnership on Infectious Disease, Jakarta, Indonesia, E-mails: retnaindah.sugiyono@ina-respond.net, nsusanto@ina-respond.net, and hkosasih@ina-respond.net. Aly Diana, Indonesia Research Partnership on Infectious Disease, Jakarta, Indonesia and Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Sumedang, Indonesia, E-mail: diana.aly@gmail.com. Dewi Lokida, Department of Clinical Pathology, Tangerang District Hospital, Tangerang, Indonesia, E-mail: lokidadewi@yahoo.com. Aaron Neal and Sophia Siddiqui, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, E-mails: aaron.neal@nih.gov and ssiddiqui@niaid.nih.gov. Chuen-Yen Lau, HIV Dynamics and Replication Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, E-mail: chuen-yen.lau@nih.gov.

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