Rafael Blanquer1, Teresa Rodrigo2, Martí Casals3, Juan Ruiz Manzano4, José María García-García5, José Luís Calpe6, Eulalia Valencia7, Teresa Pascual8, Isabel Mir9, María Ángeles Jiménez10, Fernando Cañas11, Rafael Vidal12, Antón Penas13, Joan A Caylà3. 1. Servicio de Neumología, Hospital Universitario Dr. Peset, Valencia, España; Programa Integrado de Investigación en Tuberculosis de SEPAR (PII-TB). Electronic address: rafa267.rb@gmail.com. 2. Fundación Respira de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, España; Programa Integrado de Investigación en Tuberculosis de SEPAR (PII-TB); Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP). 3. Agencia de Salud Pública de Barcelona, Barcelona, España; Programa Integrado de Investigación en Tuberculosis de SEPAR (PII-TB); Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP). 4. Servicio de Neumología, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, España; Programa Integrado de Investigación en Tuberculosis de SEPAR (PII-TB); Centro de Investigación Biomédica en Red de Respiratorio (CIBERESP). 5. Servicio de Neumología, Hospital San Agustín, Avilés, Asturias, España; Programa Integrado de Investigación en Tuberculosis de SEPAR (PII-TB). 6. Servicio de Neumología, Hospital La Marina Baixa, Villajoyosa, Alicante, España; Programa Integrado de Investigación en Tuberculosis de SEPAR (PII-TB). 7. Servicio de Enfermedades Infecciosas, Hospital Carlos III, Madrid, España; Programa Integrado de Investigación en Tuberculosis de SEPAR (PII-TB). 8. Servicio de Neumología, Hospital de Cabueñes, Gijón, Asturias, España; Programa Integrado de Investigación en Tuberculosis de SEPAR (PII-TB). 9. Servicio de Neumología, Hospital son Llàtzer, Palma de Mallorca, Islas Baleares, España; Programa Integrado de Investigación en Tuberculosis de SEPAR (PII-TB). 10. Unidad de Prevención y Control de la Tuberculosis, Barcelona, España; Programa Integrado de Investigación en Tuberculosis de SEPAR (PII-TB). 11. Hospital Insular de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, España; Programa Integrado de Investigación en Tuberculosis de SEPAR (PII-TB). 12. Servicio de Neumología, Hospital de Vall d'Hebron, Barcelona, España; Programa Integrado de Investigación en Tuberculosis de SEPAR (PII-TB). 13. Servicio de Neumología, Complejo Hospitalario Xeral-Calde, Lugo, España; Programa Integrado de Investigación en Tuberculosis de SEPAR (PII-TB).
Abstract
INTRODUCTION: The magnitude of current resistance to antituberculosis drugs in Spain is unknown. The objective of this study is to describe resistance to first-line antituberculosis drugs and determine the associated factors. METHODS: Prospective multicenter study of adult tuberculosis patients with positive Mycobacterium tuberculosis culture and antibiogram including first-line drugs in 32 hospitals and one out-patient center of the Spanish Health System between 2010 and 2011. RESULTS: A total of 519 patients, 342 Spanish nationals and 177 (34.1%) foreigners were studied. Drug resistance was found in 48 (9.2%), of which 35 (6.7%) were isoniazid-resistant. There were 10 (1.9%) multiresistant cases and no strain was extremely resistant. Initial isoniazid resistance was detected in 28 of the 487 (5.7%) antituberulosis-naïve patients, most of whom were foreigners (P<.01). Acquired resistance was seen in 7 (22.6%) previously treated cases. Multiresistance was initial in 6 cases (1.2%) and acquired in another 4 (12.9%). Factors associated with initial isoniazid resistance were immigrant status and group cohabitation OR=2.3; 95%CI: .98-5.67 and OR=2.2; 95%CI: 1.05-7.07 respectively). The factor associated with acquired resistance to isoniazid was age below 50 years (P=.03). CONCLUSIONS: The rate of initial isoniazid resistance is greater than estimated, probably due to the increase in immigration during recent years, suggesting that systematic national monitoring is required. Immigrants and those who cohabit in groups have a higher risk of isoniazid resistance.
INTRODUCTION: The magnitude of current resistance to antituberculosis drugs in Spain is unknown. The objective of this study is to describe resistance to first-line antituberculosis drugs and determine the associated factors. METHODS: Prospective multicenter study of adult tuberculosispatients with positive Mycobacterium tuberculosis culture and antibiogram including first-line drugs in 32 hospitals and one out-patient center of the Spanish Health System between 2010 and 2011. RESULTS: A total of 519 patients, 342 Spanish nationals and 177 (34.1%) foreigners were studied. Drug resistance was found in 48 (9.2%), of which 35 (6.7%) were isoniazid-resistant. There were 10 (1.9%) multiresistant cases and no strain was extremely resistant. Initial isoniazid resistance was detected in 28 of the 487 (5.7%) antituberulosis-naïve patients, most of whom were foreigners (P<.01). Acquired resistance was seen in 7 (22.6%) previously treated cases. Multiresistance was initial in 6 cases (1.2%) and acquired in another 4 (12.9%). Factors associated with initial isoniazid resistance were immigrant status and group cohabitation OR=2.3; 95%CI: .98-5.67 and OR=2.2; 95%CI: 1.05-7.07 respectively). The factor associated with acquired resistance to isoniazid was age below 50 years (P=.03). CONCLUSIONS: The rate of initial isoniazid resistance is greater than estimated, probably due to the increase in immigration during recent years, suggesting that systematic national monitoring is required. Immigrants and those who cohabit in groups have a higher risk of isoniazid resistance.