Trend in rifampicin-, multidrug- and extensively drug-resistant tuberculosis in Italy, 2009–2016

Abstract

Tuberculosis (TB) caused by strains of Mycobacterium tuberculosis that are rifampicin-resistant (RR), multidrug-resistant (MDR) (strains resistant to at least isoniazid and rifampicin) or extensively drug-resistant (XDR) (MDR strains resistant to any fluoroquinolone (FQ) and to at least one second-line injectable drug (SLID): kanamycin, capreomycin or amikacin) is a major threat to TB control globally. All three groups require treatment with second-line drugs (SLDs) [1]. We previously reported that MDR-and XDR-TB in Italy occurred mostly in foreign-born persons (FBPs) [2,3], but no major information on RR, MDR or XDR trends in FBPs and Italian-born persons (IBPs) were shown. Here, we documented these trends from 2009 to 2016 (figure 1).In our country, the surveillance of drug-resistant TB is coordinated by the World Health Organization (WHO) Supranational Reference Laboratory (SRL) in Rome collaborating with the Italian Multicentre Study on Resistance to Antituberculosis Drugs (SMIRA), a laboratory network presently comprised of 42 laboratories in 18 out of 20 regions, and with the WHO SRL in Milan. In 2015, the SMIRA network, which is periodically examined by first-line drug and SLD proficiency testing exercises [2,4], covered 69.3% of nationwide notified cases [5] and contributed the majority of cases included in annual reports of European Centre for Disease Prevention and Control/WHO.In 2009-2016, a total of 15 985 M. tuberculosis strains from TB patients with known nationality (mean±SD 2004±121 strains per year) were isolated. Strains from patients with unknown nationality (n=3083) were not included in the study. Figure 1a shows that most MDR/RR strains were isolated from FBPs, and that MDR and RR (any resistance to rifampicin, whether monoresistance, polyresistance, MDR or XDR) rates in FBPs decreased in parallel with those of FBPs+IBPs. MDR rates in FBPs+IBPs decreased with a mean annual change of −3.8%, in keeping with −2.8% and −3.8% MDR-TB decline reported for the European region in 2004-2013 [6] and 2008-2012 [7], respectively. In IBPs, the RR rates decreased while MDR rates stabilised at 0.6±0.1%.Starting from 2011, the SMIRA laboratories determined SLD susceptibility, and from 2011 to 2016, reported data on 375 MDR strains isolated from 12 240 TB cases, including 300 MDR cases from 6845 FBPs and 75 MDR cases from 5395 IBPs. The trends showed that resistance of 300 FBP strains to both FQs and SLIDs (XDR strains) was stable (10.8±1.6%) (figure 1b). Despite data fluctuations, trends were quite stable also for resistance to FQs (22.6±5%) and SLIDs (27.4±4%), and for susceptibility to SLIDs+FQs (48.1±7.3%). As to the 75 IBP strains, the corresponding values were 1.9±1.6%, 4.1±3%, 5.5±2.9% and 7.6±5.3%, respectively, indicating that resistances to SLIDs and/or FQs were much lower in IBPs than in FBPs.Out of 15 985 M. tuberculosis strains examined, 7248 (45.3%) were isolated from IBPs and 8737 (54.7%) from FBPs who had arrived in Italy from 107 countries, including 65 countries with non-MDR and 42 with MDR s...

Clindamycin as unique antibiotic choice in Hidradenitis Suppurativa

“…Indeed, Namasivayam et al have studied the impact of tuberculosis (TB) antimicrobial treatment (each antibiotic alone and in combination) on the diversity and composition of the intestinal microbiota in infected mice, demonstrating the main role played by RF on anti‐TB treatment induced dysbiosis (Namasivayam et al, ). for the potential repercussions on the therapy of TB, when considering RF, the importance of this molecule as a cornerstone of TB therapy must take into account. In Italy (2009–2016), an increase in the number of RF‐resistant (RR) Mycobacterium tuberculosis strains has been recorded in foreign‐born persons (Eastern Europe, Former Soviet Unit, Sub‐Saharan Africa), whereas, if multidrug‐resistant (MDR) (strains resistant to at least isoniazid and RF) strains are considered, this phenomenon is evident both in Former Soviet Unit and Sub‐Saharan Africa‐born persons (Mustazzolu et al, ). In order to preserve RF (avoiding a further increase in RR strains), it is important not to use RF monotherapy (CL has no anti‐tuberculosis properties, although it may have activity against atypical mycobacteria) in patients with HS and unknown TB (latent tuberculosis infection [LTBI] or TB disease) simultaneously (Mendes‐Bastos et al, ).…”

“…(responsible for CL metabolism) (Sousa, Pozniak, & Boffito, 2008 (Mustazzolu et al, 2018). In order to preserve RF (avoiding a further increase in RR strains), it is important not to use RF monotherapy (CL has no anti-tuberculosis properties, although it may have activity against atypical mycobacteria) in patients with HS and unknown TB (latent tuberculosis infection [LTBI] or TB disease) simultaneously (Mendes-Bastos et al, 2017).…”

<p>Multidrug-Resistant Tuberculosis In A Referral Center In Rome: 2011– 2016</p>

“…In a study recently published by Mustazzoli et al18 based, as our study, on culture-confirmed TB and phenotypic DST results collected during approximately the same period (2009–2016) in the whole country, 54.7% of TB cases in Italy were of foreign origin and 4.4% of these were MDR (3% in the overall TB population). Similarly to our results, the MDR cases presented in the national study were mostly from East European countries, although they found the highest rates of patients born in Ukraine.…”

Drug-Resistant Tuberculosis 2020: Where We Stand

“…At the global level, 3.4% of new cases (patients never treated with anti-TB medicines, or treated for < 1 month) and 18% of previously treated cases (patients treated for ≥ 1 month in the past) had MDR/RR-TB, with the highest proportion occurring in the former Soviet Union (FSU) countries. In the low incidence countries of the European Economic Area, the MDR-TB was more prevalent among migrants (particularly from the FSU) than the native population [4,5].…”