Begoña Santiago1, Fernando Baquero-Artigao, Asunción Mejías, Daniel Blázquez, María Soledad Jiménez, María José Mellado-Peña. 1. From the *Paediatric Infectious Diseases Unit, Gregorio Marañón Hospital; †Molecular ImmunoBiology Laboratory, Health Reseach Institute Gregorio Marañón (IiSGM), Madrid, Spain; ‡Paediatric Infectious Diseases Unit, La Paz Hospital, Madrid, Spain; §Division of Paediatric Infectious Diseases, Center for Vaccines and Immunity, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH; ¶Immunodeficiency Unit, 12 de Octubre University Hospital; ‖Mycobacterial Laboratory, National Centre of Microbiology and **Paediatrics Department, Carlos III Hospital, Madrid, Spain.
Abstract
BACKGROUND: The rates of isoniazid (INH) and multidrug-resistant (MDR) tuberculosis (TB) among European children vary between 10.4% and 3.5%. Spain is a low endemic country with reported rates of 4.9% of INH resistance and 1.3% of MDR in adults. However, data regarding patterns of TB resistance in children are scarce. Our aim is to determine the incidence and risk factors for pediatric-resistant TB in our setting to help developing age-targeted guidelines. METHODS: A multicenter, retrospective study including 22 hospitals from Madrid region (EREMITA study group) was performed from January 2005 to June 2010. Medical records from children diagnosed with TB were reviewed for demographic characteristics, clinical presentation and outcomes. Risk factors for INH and MDR TB were identified. RESULTS: Of 396 children diagnosed with TB, 72.4% were born to foreign parents. Microbiologic confirmation by culture (n = 200) or PCR (n = 8) was documented in 208 children (52.5%). Drug susceptibility results were available in 188 children: 9.6% (n = 18) were resistant to INH and 3.1% (n = 6) were MDR. INH resistance was more common in immigrants compared with native families (11.9% vs. 0%; P = 0.013), as was also MDR (4.5% vs. 0%; P = 0.34). Extrapulmonary TB and previous antituberculous treatment were significantly associated with INH and MDR, while immunosuppression was associated only with MDR. CONCLUSIONS: The rates of INH and MDR TB were different according to the parents' origin, with higher rates among children born to foreign parents. Local surveillance of drug-resistant TB is critical to develop appropriate guidelines for treatment.
BACKGROUND: The rates of isoniazid (INH) and multidrug-resistant (MDR) tuberculosis (TB) among European children vary between 10.4% and 3.5%. Spain is a low endemic country with reported rates of 4.9% of INH resistance and 1.3% of MDR in adults. However, data regarding patterns of TB resistance in children are scarce. Our aim is to determine the incidence and risk factors for pediatric-resistant TB in our setting to help developing age-targeted guidelines. METHODS: A multicenter, retrospective study including 22 hospitals from Madrid region (EREMITA study group) was performed from January 2005 to June 2010. Medical records from children diagnosed with TB were reviewed for demographic characteristics, clinical presentation and outcomes. Risk factors for INH and MDR TB were identified. RESULTS: Of 396 children diagnosed with TB, 72.4% were born to foreign parents. Microbiologic confirmation by culture (n = 200) or PCR (n = 8) was documented in 208 children (52.5%). Drug susceptibility results were available in 188 children: 9.6% (n = 18) were resistant to INH and 3.1% (n = 6) were MDR. INH resistance was more common in immigrants compared with native families (11.9% vs. 0%; P = 0.013), as was also MDR (4.5% vs. 0%; P = 0.34). Extrapulmonary TB and previous antituberculous treatment were significantly associated with INH and MDR, while immunosuppression was associated only with MDR. CONCLUSIONS: The rates of INH and MDR TB were different according to the parents' origin, with higher rates among children born to foreign parents. Local surveillance of drug-resistant TB is critical to develop appropriate guidelines for treatment.
Authors: Elizabeth P Harausz; Anthony J Garcia-Prats; Stephanie Law; H Simon Schaaf; Tamara Kredo; James A Seddon; Dick Menzies; Anna Turkova; Jay Achar; Farhana Amanullah; Pennan Barry; Mercedes Becerra; Edward D Chan; Pei Chun Chan; Domnica Ioana Chiotan; Aldo Crossa; Peter C Drobac; Lee Fairlie; Dennis Falzon; Jennifer Flood; Medea Gegia; Robert M Hicks; Petros Isaakidis; S M Kadri; Beate Kampmann; Shabir A Madhi; Else Marais; Andrei Mariandyshev; Ana Méndez-Echevarría; Brittany Kathryn Moore; Parpieva Nargiza; Iveta Ozere; Nesri Padayatchi; Saleem- Ur-Rehman; Natasha Rybak; Begoña Santiago-Garcia; N Sarita Shah; Sangeeta Sharma; Tae Sun Shim; Alena Skrahina; Antoni Soriano-Arandes; Martin van den Boom; Marieke J van der Werf; Tjip S van der Werf; Bhanu Williams; Elena Yablokova; Jae-Joon Yim; Jennifer Furin; Anneke C Hesseling Journal: PLoS Med Date: 2018-07-11 Impact factor: 11.069
Authors: Jennifer L Guthrie; Andy Delli Pizzi; David Roth; Clare Kong; Danielle Jorgensen; Mabel Rodrigues; Patrick Tang; Victoria J Cook; James Johnston; Jennifer L Gardy Journal: J Infect Dis Date: 2018-08-24 Impact factor: 5.226