Differentiated Approaches to the Choice of Timing of Surgical Treatment for Intrathoracic Lymph Node Tuberculosis in Children during Increasing Incidence of Multiple Drug Resistant Tuberculosis

Objective — to study the features of multidrug-resistant tuberculosis of the lungs of respiratory organs in children and adolescents from focuses of chemoresistant tuberculosis infection. 
 Materials and methods. To study the features of the course of multidrug-resistant pulmonary tuberculosis (MDR-TB), an analysis of clinical, X-ray, microbiological, and generally accepted laboratory examinations was conducted in 256 patients (102 children and 154 adolescents), who were divided into two groups The main group included 145 patients with MDR-TB: of them, 67 (42.2 %) children and 78 (53.8 %) teenagers from focuses of multidrug-resistant tuberculosis infection (MDR-TBI). The control group consisted of 146 patients with «chemosusceptible» pulmonary tuberculosis (CS-TB), of which 70 (47.9 %) were children and 76 (52.1 %) were adolescents from focuses of chemosusceptible tuberculosis infection (CS-TBI).
 Results and discussion. In children with multidrug-resistant pulmonary tuberculosis (MDR-TB), along with classic forms of tuberculosis (primary tuberculosis complex — 14.9 % and tuberculosis of the intrathoracic lymph nodes — 14.9 %), miliary tuberculosis (11.9 %), tuberculosis of the lungs and central nervous system (5.9 %), caseous pneumonia (8.9 %) and fibro-cavernous tuberculosis (4.5 %) were diagnosed. In the case of MDR-TB of the lungs, adolescents were statistically significantly more likely to be diagnosed with infiltrative tuberculosis (29.4 %) and disseminated pulmonary tuberculosis (35.9 %). At the same time, destructive changes were observed 1.6 times more often in adolescents with MDR-TB than in children, especially with multiresistant specific process (70.5 % vs. 43.3 %, p < 0.05).In children with MDR-TB, 3.5 times more often than in chemosusceptible tuberculosis, signs of the progression of a specific process due to lymphogenous and hematogenous dissemination in the form of tuberculosis of peripheral, intrathoracic and mesenteric lymph nodes, miliary tuberculosis were observed in adolescents, along with complications of a specific complications of a non-specific nature were observed: respiratory failure and non-specific catarrhal endobronchitis). In both children and adolescents, the intensity of bacterial excretion is greater in the presence of MDR-TB than in CS-TB. In the foci of multiresistant infection, an almost complete coincidence of the nature of MTB resistance in children with the source of infection was established. However, teenagers are most often found to be resistant to the combination of HRSE (66.1 %), HRESZ (13.6 %), unlike adults and children.
 Conclusions. The majority of contact children and adolescents with MDR-TB was detected when referring to a general practitioner or a pediatrician (62.3 % of children and 70.5 % of adolescents), which became the main reason for underdiagnosis of tuberculosis in children and adolescents in general. Our studies show the importance of a thorough examination of all contact children and adolescents in focuses of tuberculosis infection: anamnesis studies, tuberculin diagnostics (quantiferon test), clinical, radiological and microbiological examination for the timely detection of tuberculosis or infection and the appointment of appropriate chemotherapy or chemoprophylaxis.

Diagnosing tuberculosis in children is very difficult. There are no clear diagnostic criteria for intrathoracic lymph node (ITLN) tuberculosis, the most common form of tuberculosis in children (78%). Current immunological methods used in combination with computed tomography make it possible to characterize a child’s status more clearly and to establish a correct diagnosis. The positive results of immunological tests in the presence of Mycobacterium tuberculosis infection require a set of radiological examination. ITLN tuberculosis is characterized by the fact that one group or more contains single or multiple ITLNs that measure more than 5 cm and differ in structure and density in the presence of positive immunological tests (Diaskintest and QuantiFERON test).

Objective: To evaluate the sensitivity of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) puncture to obtain intrathoracic lymph node samples combined with Xpert MTB/RIF (Xpert) detection for the diagnosis of intrathoracic lymph node tuberculosis. Methods: From March 2018 to June 2021, 106 patients [55 males and 51 females, age (45.1±18.6) years] with suspected intrathoracic lymph node tuberculosis and EBUS-TBNA were collected in Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine, including 64 patients with subsequent diagnosis of intrathoracic lymph node tuberculosis and 42 patients without tuberculosis. Xpert test and traditional etiology test were performed on the patients' intrathoracic lymph node puncture specimens. The positive results of different detection methods and different methods were analyzed, and the influencing factors of Xpert independent detection positive were analyzed by univariate and multivariate logistic regression. Results: The sensitivity of Xpert was 65.6% (95%CI: 52.7%-77.1%), the specificity was 97.6% (95%CI: 87.4%-99.9%), the positive predictive value was 97.7% (95%CI: 85.7%-99.7%), the negative predictive value was 65.1% (95%CI: 57.0%-72.4%). The positive rate of Xpert alone (65.6%, 42/64) was not significantly different from that of MGIT960, histopathology and Xpert combined detection (70.3%, 45/64) (P<0.05). Multivariate logistic regression analysis showed that the location of the diseased lymph nodes in the mediastinum (OR=5.84, 95%CI: 1.112-30.704, P=0.037), necrosis in the lymph nodes (OR=6.32, 95%CI: 1.460-27.384, P=0.014), and the axial depth of the lymph nodes≥17 mm (OR=6.61, 95%CI: 1.408-30.969, P=0.017) were the promoting factors for the positive Xpert test. Conclusions: EBUS-TBNA combined with Xpert detection has a high clinical diagnostic value for intrathoracic lymph node tuberculosis. When the number of puncture samples is small, Xpert detection can be preferred. The positive rate of Xpert detection can be improved by selecting lymph nodes with mediastinal lesions, lymph nodes necrosis, and axial lymph nodes depth≥17 mm for puncture.

Background Intrathoracic lymph node tuberculosis (ITLNTB) is an extra-pulmonary manifestation of tuberculosis (TB) and a predominant feature of primary TB in children. Historical literature supports the key role of lymph nodes in tuberculosis pathogenesis yet there is a paucity of literature describing ITLNTB in adults. Methods This study comprehensively reviewed the clinical, radiological and pathological features of ITLNTB from 2009–2012 at a busy urban tuberculosis clinic. Results 113 adult patients with ITLNTB were identified between 2009–2012. Patients were usually male, with a mean age of 41.5 ± 15.8 years and mostly from White, Black-African or Indian ethnic groups. 86% were non-UK born and most presented within 5–10 years of entering the country. 43% were asymptomatic. A subgroup of patients who were mycobacterial culture positive on endobronchial ultrasound sampling (EBUS) of intrathoracic lymph nodes were identified as patients with definite mycobacterial infection of the lymph nodes (n = 27). Comparisons between symptomatic and asymptomatic groups in the whole cohort and EBUS culture positive subgroup demonstrated significant associations between symptoms and disease dissemination (p = 0.0002 and p = 0.01 respectively); and symptoms and cytological response in the lymph nodes (p = 0.02 and p = 0.01 respectively), suggesting the presence of a spectrum of disease reflected in congruent clinical and pathological responses (Table 1). Comparisons between disease sites affected also showed a significant association between host response in the lymph nodes and disease dissemination (p = 0.006). The presence of radiological necrosis, number of affected nodal stations, and largest node size were significantly greater in symptomatic patients in the whole cohort; with a similar trend observed in the EBUS culture positive subgroup. In the EBUS culture positive subgroup, asymptomatic patients were identified significantly earlier following entry to the UK (p = 0.01). Discussion This study provides the first comprehensive clinical description of ITLNTB in adults. There is a spectrum of disease based on clinical severity, disease phenotype and diagnostic and radiological findings. Host response in the lymph nodes is reflected by both symptom manifestation and disease dissemination, implicating the lymph nodes in a critical role in the natural history of TB infection. Finally, a subclinical phenotype was identified, suggesting an early stage of disease progression in TB.

BACKGROUND. The World Health Organization (WHO) reports an unknown contact history of pediatric tuberculosis (TB), especially in children younger than 5 years old. Tracing pediatric household contacts of patients with multidrug-resistant TB (MDR-TB) is considered to be a highly effective intervention for detection of new cases of chemoresistant TB in children and timely prevention of its transmission. OBJECTIVE. To study the nature of TB process manifestations and concordance of mycobacterium tuberculosis (MBT) drug resistance profiles in household child contacts of patients with MDR-TB. MATERIALS AND METHODS. The nature of TB process manifestations and concordance of MBT drug resistance profiles in 12 household child contacts of patients with MDR-TB in 6 households (6 adult MDR-TB index patients, IP) were studied. Adults and children were examined and treated in the Pulmonary Tuberculosis Department No 3 and in the Pediatric Department of the Clinical Base of the Department of Phthisiology and Pulmonology of Zaporizhzhia State Medical University at the Municipal Institution “Zaporizhzhia Regional Tuberculosis Clinical Dispensary”. RESULTS AND DISCUSSION. The tracing of children who were household contacts of the MDR-TB IP revealed the following features. The incidence of child TB was 2 times higher than that of contact adults (44 % vs. 20 %). Moreover, the incidence among children younger than 2 years of age was almost 3 times higher than in children across other age groups (54.5 % vs. 18.2 % in children younger than 5 years of age and 18.2 % in children aged 5 years and older). The children were non-BCG vaccinated in 63.6 % of cases. There was an alarmingly high rate of non-BCG vaccinated children, namely 83.3 % among individuals younger than 2 years of age and all of those younger than 5 years of age (100 %). The children mostly presented small clinical forms of non-destructive TB: intrathoracic lymph node TB (36.4 %), MBT complex (36.4 %) and focal TB (18.2 %). Most of the children (63.6 %) who developed TB were detected within the first year of IP with MDR-TB follow-up, and it is worthy of note that in the majority of cases (4 households; 66.6 %). With respect to the concordance of MBT drug resistance profiles between the children and MDR-TB IP in the households, diagnosis in children was microbiologically confirmed in only 3 cases (3 households) demonstrating the complete concordance of profiles in each one. At the same time, the complete concordance of MBT drug resistance profiles between adult household contacts and the MDR-TB IP was also recorded in 3 cases. As is evident, across the household contacts group aged between 0 and 18 years who were exposed to the MDR-TB IP, the most susceptible to develop TB were non-BCG vaccinated children younger than 2 years. More worryingly is that among 3 microbiologically conformed individuals of this age group, 2 children younger than 2 years were found to have their own drug resistant MTB isolates. CONCLUSIONS. Tracing household child contacts of MDR-TB IP is particularly effective for timely detection of active TB within the first year of MDR-TB IP follow-up. Non-BCG vaccinated children younger than 2 years of age are at the highest risk for MDR-TB followed by non-BCG vaccinated children younger than 5 years of age. The early detection and timely antimycobacterial therapy initiation based on drug susceptibility test results of a MDR-TB IP is a guarantee not only for an effective treatment but also for a reduction in the MDR-TB transmission to other persons.

The article presents a rare case of the isolation of a large calcified lesion in a 1-year-old child A., who was treated for tuberculosis of the intrathoracic lymph nodes, after family contact with his grandfather, a patient with fibrocavernous tuberculosis with bacterial isolation. Bronchi and lymphatic vessels are the main routes of spread of the tuberculosis process in the lungs, and in some cases reactivation of tuberculosis foci is possible. This may be due to damage and destruction of the bronchial wall. Residual tuberculous changes, caseous masses can carry a certain danger in the form of their breakthrough into the lumen of the trachea and bronchus. Aspiration of the contents contributes to the spread of tuberculosis infection; atelectasis, atelectatic pneumonia, etc. may occur. In early childhood, asphyxia with sudden death (suffocation by caseous masses) can occur. During the treatment of tuberculosis, you may encounter rare manifestations of the X-ray picture, the details of which must be assessed in time to choose the right tactics for patient management. In the presented case, the patient did not have activation of residual tuberculous changes; a large calcified lesion was coughed up due to the disintegration of dystrophic changes in the trachea in the affected area. A favorable outcome was recorded.

Background Patients with pulmonary sarcoidosis or intrathoracic lymph node tuberculosis (TB) may present with comparable clinical manifestations that pose challenges in differentiation. This study aims to improve the diagnostic accuracy of pulmonary sarcoidosis. Methods A retrospective analysis of patients diagnosed with pulmonary sarcoidosis or intrathoracic lymph node TB within the past decade at four tertiary hospitals in China was conducted. According to the inclusion and exclusion criteria, a total of 968 patients were ultimately enrolled in the study, comprising 477 individuals diagnosed with pulmonary sarcoidosis and 491 individuals diagnosed with intrathoracic lymph node TB. The analysis focused on general information, clinical manifestations, and auxiliary examination results, with a comparative analysis between the two groups. Results The median age of onset for pulmonary sarcoidosis was 50 years, with females accounting for 68.94% of the patients. Common symptoms of pulmonary sarcoidosis included cough, sputum production, dyspnea, and chest pain, while approximately 34.12% of patients were asymptomatic. Fever, fatigue, and night sweats occurred less frequently in pulmonary sarcoidosis patients than in those with intrathoracic lymph node TB. Uveitis and myocardial sarcoidosis were observed exclusively in pulmonary sarcoidosis patients. The median time from symptom onset to the diagnosis of pulmonary sarcoidosis was up to three months. Approximately 47.29% of pulmonary sarcoidosis patients had reduced peripheral blood lymphocyte counts, and 94.12% exhibited symmetric enlargement of hilar lymph nodes on chest CT. Both pulmonary sarcoidosis and intrathoracic lymph node TB showed granulomatous inflammation, with 64.36% of intrathoracic lymph node TB cases presenting necrotic foci. Bronchoscopy was the primary method for biopsy, and only 11.06% of pulmonary sarcoidosis patients had multiple nodules in the tracheal or bronchial mucosa, with a low positivity rate for pathogen tests. Conclusion Pulmonary sarcoidosis predominantly affects middle-aged and young women and can be differentiated from intrathoracic lymph node TB by the presence of uveitis and myocardial sarcoidosis, although these manifestations are rare. A significant proportion of pulmonary sarcoidosis patients experience a reduction in their peripheral blood lymphocyte count. Chest CT scans often reveal symmetric bilateral enlargement of hilar lymph nodes, and in some cases, multiple nodules in the tracheal or bronchial mucosa. Both pulmonary sarcoidosis and intrathoracic lymph node TB show granulomatous inflammation, but tuberculosis lesions are more likely to necrose.

<sec> <title>BACKGROUND</title> Diagnosis of tuberculosis (TB) in children remains challenging due to the paucibacillary nature of the disease. Detection of TB using urine lipoarabinomannan (LAM) antigen was evaluated in children with presumed TB. </sec> <sec> <title>MATERIAL and METHODS</title> Children with presumed intrathoracic tuberculosis (ITTB) and lymph node TB (LNTB) were enrolled. Expectorated or induced sputum or gastric aspirates from ITTB patients and fine-needle cytological aspirates from LNTB patients were subjected to Ziehl-Neelsen staining, MGIT™960™ culture and Xpert® MTB/RIF testing. Urine samples were tested to detect LAM, and the sensitivity and specificity calculated. </sec> <sec> <title>RESULTS</title> Of 280 children with presumed ITTB and 101 with presumed LNTB, respectively 71 (25.3%) and 25 (24.7%) were categorised as 'confirmed TB', 70 (25%) and 33 (32.7%) as 'unconfirmed TB', and 139 (49.6%) and 43 (42.5%) as 'unlikely TB'. Respectively 8 (2.8%) children with ITTB and 3 (2.9%) with LNTB were positive on smear, 56 (20.0%) and 23 (22.7%) on Xpert, and 50 (17.8%) and 9 (8.9%) on culture. LAM assay sensitivity was 73.2% in confirmed ITTB cases, and 76% in confirmed LNTB cases; LAM assay specificity in children with ITTB and those with LNTB initiated on anti-tuberculosis treatment was respectively 92% and 93%. Detection of TB using the LAM assay was significantly better than detection using Xpert (P < 0.05 vs. P < 0.002). </sec> <sec> <title>CONCLUSION</title> Urinary LAM testing showed high specificity and sensitivity, was detected in more cases initiated on treatment than reference tests, and improved disease detection by 38.5% in ITTB patients and by 41.6% in LNTB patients. </sec>.

< sec> < title>BACKGROUND< /title> Diagnosis of tuberculosis (TB) in children remains challenging due to the paucibacillary nature of the disease. Detection of TB using urine lipoarabinomannan (LAM) antigen was evaluated in children with presumed TB. < /sec> < sec> < title>MATERIAL and METHODS< /title> Children with presumed intrathoracic tuberculosis (ITTB) and lymph node TB (LNTB) were enrolled. Expectorated or induced sputum or gastric aspirates from ITTB patients and fine-needle cytological aspirates from LNTB patients were subjected to Ziehl-Neelsen staining, MGIT™960™ culture and Xpert® MTB/RIF testing. Urine samples were tested to detect LAM, and the sensitivity and specificity calculated. < /sec> < sec> < title>RESULTS< /title> Of 280 children with presumed ITTB and 101 with presumed LNTB, respectively 71 (25.3%) and 25 (24.7%) were categorised as 'confirmed TB', 70 (25%) and 33 (32.7%) as 'unconfirmed TB', and 139 (49.6%) and 43 (42.5%) as 'unlikely TB'. Respectively 8 (2.8%) children with ITTB and 3 (2.9%) with LNTB were positive on smear, 56 (20.0%) and 23 (22.7%) on Xpert, and 50 (17.8%) and 9 (8.9%) on culture. LAM assay sensitivity was 73.2% in confirmed ITTB cases, and 76% in confirmed LNTB cases; LAM assay specificity in children with ITTB and those with LNTB initiated on anti-tuberculosis treatment was respectively 92% and 93%. Detection of TB using the LAM assay was significantly better than detection using Xpert (P < 0.05 vs. P < 0.002). < /sec> < sec> < title>CONCLUSION< /title> Urinary LAM testing showed high specificity and sensitivity, was detected in more cases initiated on treatment than reference tests, and improved disease detection by 38.5% in ITTB patients and by 41.6% in LNTB patients. < /sec>. PMID: 31315704

Tuberculosis (TB) in children is a complex of medical, biological and social problem of both international and national importance for many countries of the world and remains one of the main causes of death in the world. Surgical treatment can improve the results of treatment of children with TB.Objective — to familiarize a wide range of doctors with their own experience in the surgical treatment of children and adolescents with pulmonary TB.Materials and methods. The results of surgical treatment of 79 children with lung tuberculosis in the period from 2008 to 2018 are reported.Results and discussion. Male adolescents prevailed among the operated patients. The male/female sex ratio is 45 (57.0 %)/34 (43.0 %). The average age of patients was 13.1 years (from 4 to 17 years). The overall effectiveness of surgical treatment in the observation period up to 10 years was 97.5 %. Sputum conversion, improvement of the clinical condition, closure of the cavities and positive X-ray dynamics in 77 patients (97.5 %). Postoperative complications developed in 11 (13.9 %) patients and were eliminated conservati­vely. Recurrences of TB in the postoperative period were observed in 2 (2.5 %) patients.Conclussions. Surgical treatment is possible by increasing the effectiveness of treating children with TB. The peculiarity of the course of TB in children is more frequent than in adults, the impression of a specific process of the tracheobronchial tree. The overall effectiveness of surgical treatment of pulmonary TB in children in follow-up periods up to 10 years was 97.5 %. In the surgical treatment of TB of the lungs in children, preference should be given anatomical resection, the best option for surgery is lobectomy. Minimally invasive resections of the lungs have advantages over traditional surgical interventions, can reduce the injury of the operation and reduce the period of postoperative inpatient treatment. When performing resection in children with multidrug-resistant TB and preXDR TB, to prevent overdistension of the lungs, methods of correcting hemithorax volume should be used. The presence of limited destruction in the opposite lung is not an obstacle to the resection of the lung.

The article presents problems that arise during differential diagnosis of recurrent tuberculosis of intrathoracic lymph nodes in the elderly, it describes bronchial tuberculous lesions and treatment opportunities.

The article presents the results of the analysis of the epidemiological situation of tuberculosis in children of the Astrakhan region for the period from 2013 to 2017. The incidence of tuberculosis of children in the region exceeds the average Russian Federation 2.9, the southern Federal district in 3.2 time. In the structure of morbidity of children is dominated by tuberculosis of intrathoracic lymph nodes (75.6%). The increase of tuberculosis morbidity of children population of the region could also be: the increasing incidence and delayed diagnosis of tuberculosis in adults introduction in practice of modern methods of diagnostics (computer tomography, PCR, Diaskintest) allowing to identify the disease in a larger number of patients, lack of alertness of doctors of general medical network on early diagnosis of tuberculosis.

Aim: To study the characteristics of tuberculosis (TB) in children. Materials and methods: We examined 107 children with TB in Regional children tuberculous department, using clinical, radiological and bacteriological methods. Among them 63 (59%) boys and 44 (41%) girls. Children aged 0-5 years 36%, 6-10 years - 7%, 11-14 years - 11%, 15-17 years - 46%. Results: TB of intrathoracic lymph nodes was detected in 22% of children, primary tuberculous complex - 21% of children. These forms are diagnosed in patients aged upto 5 years. Infiltrative TB was observed in 35% of children, mostly aged 15-17 years. Focal tuberculosis was detected in 3%, tuberculous pleuritis in 14% of children and 2% had tuberculous meningitis. Mycobacterium tuberculosis was detected in 39 (36%) of children by culture, among them in 13 patents bacterioscopical investigation was also positive. In 16 (15%) patients were identified multidrug-resistant TB (MDR-TB), and their treatment was carried out second-line drugs. Among 24 children with tuberculosis of intrathoracic lymph nodes cultural test was positive in 4 (17%) patients, 2 of them had MDR-TB. 10 of 22 children with primary tuberculous complex had microbiologic confirmation of TB, of whom 5 kids had MDR-TB. Among 41 child with infiltrative pulmonary tuberculosis MBT was found in 24 (59%) children, of whom 9 patients had MDR-TB. 6 patients with tuberculous pleuritis had positive culture test of the pleural fluid. Conclusions: nowadays tuberculosis affects more commonly children aged 0-5 years (36%) and teenagers (46%); positive culture test and microscopy was detected in 36% of patients, predominantly in those who had lung parenchyma affection; multidrug-resistant tuberculosis was detected in 15% of children.

Background. There has been an improvement in the epidemiological situation of tuberculosis in children and adolescents in St. Petersburg. However, there are some unresolved problems Methods.Annual statistical surveillance forms for tuberculosis in children for 10 years were analysed. Medical records of in-patients identified in 2021 and 2022 were studied; the characteristics of tuberculosis contacts and ways of identification of patients were given. Results. Over the period 2013–2022, the incidence of tuberculosis in children 0-14 years decreased from 17.3 to 4.3 per 100,000, the incidence in adolescents 15-17 years – from 27.6 to 3.3 per 100,000. The course of tuberculosis was generally favourable, bacterial excretion in children was observed in 2.9% of cases, in adolescents in 29.8%. In 2022, the structure of clinical forms of tuberculosis deteriorated compared to 2021 due to a decrease in the share of tuberculosis of intrathoracic lymph nodes from 82.1% to 69.4%, and the emergence of cases of more severe course of the disease. In children who became ill in 2022, household tuberculosis contact with an adult relative was established in 38.9% of cases, half of them only after tuberculosis was diagnosed in the child. Conclusion. Detection of household contact with tuberculosis patients remains a priority method of preventing the disease in children. It is advisable to organise a monitoring system of tuberculosis infection foci in St. Petersburg.

To predict outcomes of tuberculosis we investigated the viability of Mycobacterium tuberculosis (MTB) in relation to drug resistance of strains and clinical manifestations of tuberculosis. During the study on solid Lowenstein - Jensen medium, we determined the speed, growth rate and drug resistance of MBT in 5945 cultures, isolated from the sputum of patients with pulmonary tuberculosis - residents of the Irkutsk region (2193 -from newly diagnosed patients, 3752 - from previously treated patients). The criterion of high viability of MBT was the growth rate of >100 colonies over 20 days; and low viability corresponded with the growth rate of 30 days. 2171 cultures (36.5 %) had high viability of MBT strains, 3021 (50.8 %) - low, and 753 (12.7 %) cultures had average degree of viability. A high degree of pathogen viability was more often determined in newly diagnosed patients with tuberculosis of intrathoracic lymph nodes (all patients with HIV-infection without antiretroviral therapy), fibrotic-cavernous and infiltrative tuberculosis. Among previously treated patients with tuberculosis the high viability of MBT was often determined in patients with fibrous-cavernous and infiltrative tuberculosis, and caseous pneumonia. Cultures from previously treated patients with tuberculosis of intrathoracic lymph nodes had low degree of viability. The number of drug-sensitive strains was 1992, drug-resistant ones - 3953, including 1430 strains with multidrug resistance. We have found that 37.5 % drug-resistant strains associated with a high degree of viability (multidrug resistance - 38.5 %), it's was more often than the drug-sensitive (35.4 %; p < 0.01).