Priority identification in the clinical case management of multidrug resistant Tuberculosis (MDR-TB) in Bangladesh

<b>Introduction:</b> Our study highlights&nbsp;the importance of priority case management for poor and old slum dwellers MDR-TB patients with DST before treatment selection. <b>Aims and Objective:</b> To support the essential re-evaluation of MDR-TB categorization with the drug susceptibility testing (DST) for priority case management and complication prevention in Bangladesh. <b>Methods:</b> A retrospective DST and review of medical records of the MDR-TB cases (from January to October 2021) at the National Tuberculosis Reference Laboratory were carried out. The samples were collected from different levels of country’s healthcare system and were categorized into MDR-TB, extensively drug-resistant TB&nbsp;(XDR TB)&nbsp;and Pre-XDR TB. <b>Results:</b> We identified 712 MDR-TB cases by Xpert MTB/RIF assay out of which 74 (10.39%) were previously treated patients and 125 (17.56%) were Category I relapse cases. The mean age (SD) of the cases was 61.34 (11.1) years with male predominance (64.74%). The bacteriologically positive MDR were 471(66.15%). The odds of Rifampicin Resistant TB (RR-TB) is 20 times higher in previously treated patients compared to new cases. In 2nd line probe assay, 56 (7.86%) cases showed resistance to fluoroquinolone and were declared as Pre-XDR TB among which 10.71% cases were XDR-TB. Increased age, male gender, urban residence, malnutrition, smoking, diabetes and the pulmonary cases were found to be the significant factors associated with MDR/RR-TB (p &lt; 0.05). <b>Conclusion:</b> The higher prevalence of MDR-TB in the older population indicates high latent TB infection in the younger age group. Further investigation on the latent TB case detection should be an important tool to fight MDR-TB.