Drug-resistant tuberculosis: Patterns and predictors in extrapulmonary vs pulmonary TB

Background: Drug-resistant tuberculosis (DR-TB) poses a major challenge to global TB control, with increasing incidence and poor treatment outcomes. Differences in resistance patterns between pulmonary and extrapulmonary TB remain inadequately explored. Objective: To evaluate the patterns and predictors of drug-resistant tuberculosis in pulmonary and extrapulmonary TB patients. Methodology: This was a comparative cross-sectional study conducted at Sialkot medical college Sialkot from march 2025 to march 2026 including 266 patients diagnosed with tuberculosis. Results: Drug-sensitive TB was more common in extrapulmonary TB (67.3% vs 60.3%), while MDR-TB (20.5% vs 16.4%) and mono-resistance (14.1% vs 10.9%) were slightly higher in pulmonary TB. Patients with DR-TB were older (44.8 ± 13.9 vs 40.6 ± 14.4 years) and had lower BMI (20.7 ± 3.1 vs 21.9 ± 3.3 kg/m²). Previous TB treatment (59.2% vs 26.2%), diabetes (36.7% vs 22.6%), HIV positivity (20.4% vs 11.9%), and malnutrition (53.1% vs 31.0%) were significantly associated with DR-TB. Multivariable analysis identified previous treatment (AOR 3.42), malnutrition (AOR 2.76), low BMI (AOR 2.21), diabetes (AOR 1.94), HIV (AOR 1.88), and age >45 years (AOR 1.67) as independent predictors. Conclusion: Drug-resistant TB is influenced by multiple factors, with prior treatment being the most significant predictor. Both pulmonary and extrapulmonary TB require equal attention in resistance surveillance and management strategies.

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