Extent and origin of resistance to antituberculosis drugs in the Netherlands, 1993 to 2011

Abstract

The elimination of tuberculosis (TB) is threatened by an apparent increase in the level of resistance in Mycobacterium tuberculosis. In the Netherlands, where the majority of TB patients are migrants, resistance may also be increasing. We conducted a retrospective study, using 18,294 M. tuberculosis isolates from TB cases notified between 1993 and 2011. We investigated the trends in antituberculosis drug resistance, focusing on the country of birth of the patients and whether resistance had developed during treatment or was the result of transmission of resistant M. tuberculosis strains. For both scenarios, we determined whether this had happened in or outside the Netherlands. Antituberculosis drug resistance was found in 13% of all cases analysed and showed an increasing trend among patients who had been born in the Netherlands (p<0.001) and a decreasing trend among foreign-born (p=0.02) over the study period. Since 2005, the proportion of M. tuberculosis resistant strains among all strains tested has increased in both groups (p=0.03 and p=0.01, respectively). Overall, we found a significantly increasing trend when excluding streptomycin resistance (p<0.001). The trend was most markedly increased for isoniazid resistance (p=0.01). Although resistance was mainly due to transmission of resistant strains, mostly outside the Netherlands or before 1993 (when DNA fingerprinting was not systematically performed), in some cases (n=45), resistance was acquired in the Netherlands. We conclude that antituberculosis drug resistance is increasing in the Netherlands, mostly related to migration from high TB-incidence countries, but also to domestic acquisition.

The epidemiology, pathogenesis, transmission, diagnosis, and management of multidrug-resistant, extensively drug-resistant, and incurable tuberculosis

“…For example, foreign-born individuals in the Netherlands had almost twice the risk for MDR as people born locally. 26 In Shanghai, internal migrants from other regions of China were 1·4 times more likely to develop MDR than individuals born in the city. 27 Other groups at high risk in some settings include prisoners, who were shown to have double the incidence of MDR compared with civilians in Samara Although most studies focus on individual characteristics, these host risk factors might not lead directly to MDR tuberculosis but serve as indicators of poor access to high-quality care.…”

Drug-resistance - a challenge for tuberculosis control in the European Union and European Economic Area

“…A study by C Ruesen et al from the Netherlands also evaluated all types of TB drug resistance [6]. In contrast to the overall findings for the EU/EEA, they revealed that antituberculosis drug resistance increased in the Netherlands since 1993 in patients born in the Netherlands, and since 2005, in foreign-born patients.…”

“…Also, even though more invasive, fine-needle aspiration biopsy has proved to be useful for collecting samples in children with a peripheral lymph-node mass [16]. In addition to facilitating the diagnosis of TB and drug resistance, strains obtained from positive cultures can also be subjected to molecular typing and provide valuable information about transmission of TB such as demonstrated in several studies in this issue [6,7,8].…”

The First Step for National Tuberculosis Laboratory Surveillance; Ankara, 2011

“…Türkiye geneli için AC-TB olgularının yaş ve cinsiyet dağılımına bakıldığında çalışmamızla benzer bir dağılım olduğu gözlenmiştir 14 . Çalışmamızda TB yaş ortalaması 43.4 yıl olup, farklı ülkelerden yapılan çalışmalarda da benzer sonuçlar bulunmuş, farklı olarak Etiyopya'dan yapılan bir çalışma-da yaş ortalaması 26 olarak bildirilmiştir 3,16,17 . Çalışmamız sonucunda AC-TB olgularının %94.6'sının yeni olgu olduğu saptanmıştır (Tablo III).…”

“…Dünyada ÇİD-TB oranına bakıldığında; yeni ve önceden tedavi almış olgularda sırasıyla %3.5 ve %20.5 olduğu görülmekte; DSÖ Avrupa Bölgesinde ise bu oranlar ülkemizden daha yüksek olmak üzere sırasıyla %14 ve %44 olarak verilmektedir 4 . ÇİD-TB risk faktör-lerinin değerlendirildiği pek çok çalışmada benzer şekilde önceden tedavi görmüş olma ve yabancı ülke doğumlu olma risk faktörü olarak belirtilmiştir [17][18][19][20] . DSÖ Stop TB stratejisinde, bakteriyolojik tanıya ek olarak AC-TB olgularının %85'inin başarı ile tedavisi hedefl enmektedir.…”