TB and M/XDR-TB infection control in European TB reference centres: the Achilles' heel?

Abstract

To the Editors: The emergence of multidrug-resistant (MDR) tuberculosis (TB), defined as in vitro resistance to isoniazid and rifampicin, and extensively drug-resistant (XDR)-TB, defined as in vitro drug resistance to isoniazid and rifampicin plus any fluoroquinolone and at least one of the injectable drugs (amikacin, capreomycin or kanamycin), represents a major threat to TB control at the global level [1–5]. XDR-TB is a manmade product, resulting, in essence, from clinical mismanagement of newly diagnosed susceptible and resistant TB cases [2–5]. Moreover, existing MDR/XDR-TB cases must be promptly detected and treated, and the transmission from infectious source cases has to be prevented, particularly in nosocomial settings [2–6]. The World Health Organization (WHO), in its Stop TB Strategy [7] and its recent Policy on Infection Control [8], clearly underlines the importance of implementing effective measures of infection control in clinical facilities managing TB and MDR-TB patients. At present, no international study is available to investigate how infection control measures are implemented in healthcare facilities managing TB patients. The aim of the present study was to document how infection control measures are implemented in selected settings in the European Union, focusing on national MDR/XDR-TB reference centres. A standardised and comprehensive survey tool was developed, as discussed previously [9, 10]. In summary, the tool consisted of items covering the key areas that a panel of experts considered adequate to evaluate TB infection control in the selected countries. A Delphi process was used to identify the key elements belonging to infection control, and …