Multidrug resistance in new tuberculosis patients: burden and implications [Short communication]

Abstract

In 2010, 30 countries with anti-tuberculosis drug resistance surveillance data were each estimated to have more than 700 multidrug-resistant tuberculosis (MDR-TB) cases among their notified TB cases. New TB patients comprised a median of 54% (interquartile range 45-67) of the MDR-TB cases. The occurrence of MDR-TB in a new TB patient is a warning sign that MDR-TB is spreading in a community. While MDR-TB case-finding efforts should first prioritize previously treated patients, reaching universal access requires rapidly adding other risk groups, and then all new TB patients. Epidemiological data as presented in this paper can help inform country scale-up plans.

Multidrug-Resistant Tuberculosis in Europe, 2010–2011

“…In Moldova, for which adequate surveillance data are available, 23.7% of new TB cases involve an MDR strain ( 3 ). A recent report of surveillance data in countries with >700 estimated MDR TB cases per year indicated that more than half of the reported pulmonary MDR TB cases were new cases ( 20 ). …”

“…Although previous treatment for TB and contact with persons infected with drug-resistant strains have been reported as strong risk factors for MDR TB, the role of HIV infection, young age, sex, and previous imprisonment are less clear ( 12 , 28 ). The high proportion of new cases and the lack of association of other traditional risk factors with drug-resistant TB suggest an increased role of ongoing transmission in the community outside established risk groups for becoming infected with drug-resistant strains of M. tuberculosis ( 19 , 20 , 29 ). …”

Multidrug-resistant tuberculosis in Uzbekistan: results of a nationwide survey, 2010 to 2011

“…This is expected to increase the patient coverage of DST in Uzbekistan, including the previously untreated TB patients who, as in many other countries, harbour a substantial part of the MDR-TB caseload [34]. If coupled with an efficient electronic system of data capture this would also enable the use of data from routine diagnostic testing for drug resistance surveillance in the near future.…”

Tuberculosis Multidrug-resistant Tuberculosis – From Epidemiology to Treatment Design

“…In absolute numbers, the majority of cases is observed in new patients, who never received a treatment before and who were contaminated by a patients harbouring a resistant strain. 13 As a consequence, in some regions of the world, new patients are at high risk of having MDR-TB even in the absence of previous treatment.…”