ArticleBMC microbiology2026
Factors associated with drug-resistant tuberculosis among patients at a tertiary referral hospital in Tanzania.
Article in BMC microbiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundMultidrug-resistant tuberculosis (MDR-TB) undermines global TB control, particularly in high-burden African settings, with high HIV co-infection rates. While Tanzania is among the 30 high-burden TB countries, data on resistance patterns at tertiary referral hospitals remain limited. We aimed to determine the prevalence and factors associated with drug-resistant TB among patients at Muhimbili National Hospital (MNH) in Tanzania.
methodsWe conducted a retrospective cross-sectional study of 170 TB patients managed at MNH between July 2024 and July 2025.Clinical and demographic data were extracted from hospital records. Resistance was determined using GeneXpert MTB/RIF results extracted from patient records. Rifampicin resistance (RR-TB) detected by GeneXpert was used as the operational indicator of drug-resistant tuberculosis (DR-TB) in this study. The primary outcome was DR-TB, operationally defined by rifampicin resistance detected using GeneXpert MTB/RIF. MDR-TB (resistance to at least isoniazid and rifampicin) was recorded separately when documented in patient records; however, routine isoniazid susceptibility testing was not performed for all patients, so MDR-TB prevalence reflects documented clinical diagnoses rather than systematic testing. Bivariate associations were assessed using Chi-square tests. Multivariable binary logistic regression identified factors independently associated with resistance; due to only 24 resistant cases, the model was limited to two predictors.
resultsAmong 170 patients (64.7% male; mean age 44.2 years, SD 15.6), the prevalence of DR-TB was 14.1% (24/170; 95% CI: 9.5-20.1). Of these, 22 (91.7%) had documented MDR-TB diagnoses in their medical records. On multivariable analysis (limited to two predictors due to low event numbers), HIV co-infection (aOR = 4.82, 95% CI: 1.18-19.67, p = 0.030) and known contact with an MDR-TB patient (aOR = 7.34, 95% CI: 2.45-22.01, p < 0.001) remained significantly associated with resistance. Substantial missing data (up to 78.8%) limits generalizability.
conclusionThe prevalence of DR-TB was 14.1%, considerably higher than national averages for new cases (0.9%). HIV co-infection and exposure to known MDR-TB cases were independently associated with resistance. However, these findings are exploratory and hypothesis-generating due to substantial missing data, a small number of resistant cases (n=24), and a single-center design. Prospective multicenter studies are needed to confirm these associations. Nonetheless, targeted interventions for HIV-positive patients and exposed contacts remain a priority.
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