• Plos One · Jan 2013

    From multidrug- to extensively drug-resistant tuberculosis: upward trends as seen from a 15-year nationwide study.

    • Karolien Stoffels, Caroline Allix-Béguec, Guido Groenen, Maryse Wanlin, Dirk Berkvens, Vanessa Mathys, Philip Supply, and Maryse Fauville-Dufaux.
    • National Reference Centre of Tuberculosis and Mycobacteria, Communicable and Infectious Diseases, Scientific Institute of Public Health, Brussels, Belgium.
    • Plos One. 2013 Jan 1; 8 (5): e63128.

    BackgroundEmergence of extensively drug-resistant tuberculosis (XDR-TB) represents an enormous challenge to Public Health globally.MethodsProgression towards XDR-TB was investigated in Belgium, a country with a typically low TB incidence, by analyzing the magnitude, characteristics, and treatment success of multidrug-resistant tuberculosis (MDR-TB) through a population-based study from 1994 to 2008.ResultsAmong the 174 MDR-TB patients, 81% were foreign-born, 48% of these being asylum seekers. Although the number of MDR-TB patients remained stable through the study period at around 15 new cases annually, frequencies of resistance of the patients' first MDR-TB isolate to second-line drugs increased, as well as the total number of antibiotics it was resistant to (p<0.001). XDR-TB cases were detected from 2002 onwards. For 24 patients, additional resistance to several second-line drugs was acquired during treatment. Molecular-guided investigations indicated little to no contribution of in-country clonal spread or exogenous re-infection. The increase of pre-XDR and XDR cases could be attributed to rising proportions of patients from Asia and Central and Eastern Europe (p<0.001) and an increase in the isolation of Beijing strains in these groups (p<0.001). Despite augmented resistance, the treatment success rate improved from 63.0% to 75.8% (p = 0.080) after implementation in 2005 of improved surveillance measures and therapeutic access.ConclusionsIncreasing severity in drug resistance patterns leading to more XDR- and "panresistant" TB cases in a country with a low TB incidence like Belgium represents a strong alert on worsening situations in other world regions and requires intense public health measures.

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