Multidrug-resistant tuberculosis in Europe, 2010-2011.

Gunar Günther,Valeriu Crudu,Korkut Avsar,Inge Muylle,Christoph Lange,Christina Popa,Neus Altet,Alena Skrahina,Wiel De Lange,Ana Ciobanu,Simon Tiberi,Didi Bang,Piret Viiklepp,Varvara Solodovnikova,Sofia Alexandru,Graham Bothamley,Heinke Kunst,Gina Gualano,Anne-Marie Mclaughlin,Manfred Davilovits,Raquel Duarte,Vaira Leimane,Veronika Polcová,Frank Van Leth,Emanuele Pontali,Rudolf Rumetshofer,Martin Dedicoat,Cécile Magis-Escurra ,R Bărbuţă ,Victor Spînu

doi:10.3201/eid2103.141343

Abstract

Drug-resistant Mycobacterium tuberculosis is challenging elimination of tuberculosis (TB). We evaluated risk factors for TB and levels of second-line drug resistance in M. tuberculosis in patients in Europe with multidrug-resistant (MDR) TB. A total of 380 patients with MDR TB and 376 patients with non-MDR TB were enrolled at 23 centers in 16 countries in Europe during 2010-2011. A total of 52.4% of MDR TB patients had never been treated for TB, which suggests primary transmission of MDR M. tuberculosis. At initiation of treatment for MDR TB, 59.7% of M. tuberculosis strains tested were resistant to pyrazinamide, 51.1% were resistant to ≥1 second-line drug, 26.6% were resistant to second-line injectable drugs, 17.6% were resistant to fluoroquinolones, and 6.8% were extensively drug resistant. Previous treatment for TB was the strongest risk factor for MDR TB. High levels of primary transmission and advanced resistance to second-line drugs characterize MDR TB cases in Europe.

Highlights

Terms of use This work is brought to you by the University of Southern Denmark
At initiation of treatment for MDR TB, 59.7% of M. tuberculosis strains tested were resistant to pyrazinamide, 51.1% were resistant to ≥1 second-line drug, 26.6% were resistant to second-line injectable drugs, 17.6% were resistant to fluoroquinolones, and 6.8% were extensively drug resistant
We studied a multicenter cohort of patients with MDR TB at 23 referral centers across Europe and found high rates of drug resistance to second-line drugs for treatment of TB in circulating M. tuberculosis strains, and limited availability of second-line drug resistance testing in several countries with a high incidence of TB

Summary

Introduction

Terms of use This work is brought to you by the University of Southern Denmark. Unless otherwise specified it has been shared according to the terms for self-archiving. If no other license is stated, these terms apply: Multidrug-Resistant Tuberculosis in Europe, 2010–2011. We evaluated risk factors for TB and levels of second-line drug resistance in M. tuberculosis in patients in Europe with multidrug-resistant (MDR) TB. High levels of primary transmission and advanced resistance to second-line drugs characterize MDR TB cases in Europe. Multidrug-resistant (MDR) TB is defined by in vitro resistance of Mycobacterium tuberculosis to at least both of the 2 most effective drugs for treatment (rifampin and isoniazid). MDR TB living in this region may be much higher because a substantial proportion of patients are never screened for drug-resistant TB before starting treatment, partly because of a lack of diagnostic capacity [3]

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Results

Conclusion