Drug-resistant tuberculosis in northern Germany: a retrospective hospital-based study of 1,055 patients from 1984 until 1993

Abstract

D Dr ru ug g--r re es si is st ta an nt t t tu ub be er rc cu ul lo os si is s i in n NWe reviewed the medical records of all patients with positive cultures for Mycobacterium tuberculosis from 1984 until 1993 in a hospital near Hamburg. Drug-susceptibility testing was performed for isoniazid, rifampicin, ethambutol, and streptomycin, using the modified proportion method.Of 1,055 patients, 9.6% had isolates resistant to one or more drugs. Of the isolates, 5.8% showed resistance to isoniazid or rifampicin and 1.8% to both isoniazid and rifampicin. There was no significant change of the resistance rate during the study period. Twenty six percent of 89 patients from South America, Africa or Asia had isolates resistant to one or more drugs, compared with 7.6% of 799 patients born in Germany (odds ratio (OR) 4.2; 95% confidence interval (95% CI) 2.5-7.3). Among patients born in Germany, 32% of 101 patients with a history of prior antituberculosis drug therapy had resistant organisms, versus 4.2% of 698 patients without prior therapy (OR 10.7; 95% CI 6.1-18.7). Resistance rates for 35 patients, who had been treated within the last 5 yrs, and for 65 patients, who had been treated more than 5 yrs ago, were 57 and 17%, respectively (OR 6.6; 95% CI 2.9-16.6).Our results suggest that there is no increase in the proportion of drug-resistant tuberculosis in our hospital, and that patients with a recent history of antituberculosis drug therapy and patients from South America, Africa, or Asia are at high risk for drug resistance.

Risk factors associated with drug-resistant Mycobacterium tuberculosis in Castilla-la-Mancha (Spain)

“…As opposed to the USA, in European countries, such as the UK [10] and Spain [11][12][13], the prevalence of tuberculosis resistant to treatment has not risen in recent years. In Germany, the data from two recent studies are not consistent [14,15].…”

Explaining risk factors for drug-resistant tuberculosis in England and Wales: contribution of primary and secondary drug resistance

“…HIV has been found to be a risk factor for resistance in the United States [5,[7][8][9] but not in Africa [10]. Some studies have found resistance to be associated with cavitatory pulmonary disease [11], and most studies from developed countries (particularly the United States) have found relationships with ethnic groupings [5,7], foreign birth [7,[12][13][14] and urban centres [13]. In the United Kingdom surveillance data from England and Wales have generally shown an excess of drug-resistant cases in London, in HIV-positive cases, those not born in the United Kingdom and sometimes in non-white ethnic groups [2,3,15].…”

Multidrug-resistant tuberculosis and risk factors associated with its development: a retrospective study

“…A study conducted in the United States discovered that HIV infection was also a risk factor for resistance [9][10][11][12][13]. Other risk factors reported included foreign birth, ethnicity, living in urban centers, and having cavitary pulmonary tuberculosis [9,11,[14][15][16][17]. However, most of these studies were conducted in developed countries, particularly in the United States and European countries.…”