A retrospective analysis of pulmonary and extra-pulmonary tuberculosis drug resistance in Punjab, Pakistan (2012-2022).

BACKGROUND: This study aims to investigate drug resistance patterns in pulmonary and extra-pulmonary tuberculosis (TB), including central nervous system (CNS)-TB, using the largest reference multidrug resistance laboratory in Punjab, Pakistan. METHODS: Retrospective data from 2012 to 2022 were collected from 1410 patients referred to the multidrug resistant (MDR)-TB laboratory of Mayo Hospital, Lahore, Pakistan. The drug resistant (DR) testing was performed on sputum or pleural fluid in patients with pulmonary tuberculosis, and on cerebrospinal fluid in patients with CNS-TB. RESULTS: The mean age was 35 ± 15.9 years, with a higher proportion of females (50.5 %; 712). Of the cases, 96.5 %; 1361 presented with pulmonary TB, while 4 % (56) had isolated extra-pulmonary TB. Among the extra-pulmonary cases, 1.3 % (18) had CNS-TB. A significant percentage (67.8 %; 956) exhibited MDR-TB, with 25.3 % (356) showing rifampicin resistance. Moreover, 6 % (85) demonstrated resistance to both first and second-line drugs, with 0.4 % (5) resistant to all first-line anti-TB drugs. Of the CNS-TB cases, 56 % (10) had confirmed rifampicin resistance. Most patients (81.9 %; 1152) had previously received first-line anti-TB drugs. CONCLUSION: This study underscores the high burden of DR-TB in endemic regions, and the need for further large-scale investigations to better understand resistance patterns and inform effective management strategies.