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Volume 13, Number 3—March 2007


Worldwide Emergence of Extensively Drug-resistant Tuberculosis

N. Sarita Shah*1Comments to Author , Abigail Wright†, Gill-Han Bai‡2, Lucia Barrera§2, Fadila Boulahbal¶2, Nuria Martín-Casabona#2, Francis Drobniewski**2, Chris Gilpin††2, Marta Havelkovᇇ2, Rosario Lepe§§2, Richard Lumb¶¶2, Beverly Metchock*2, Françoise Portaels##2, Maria Filomena Rodrigues***2, Sabine Rüsch-Gerdes†††2, Armand Van Deun##2, Veronique Vincent‡‡‡2, Kayla Laserson*, Charles Wells*, and J. Peter Cegielski*
Author affiliations: *Centers for Disease Control and Prevention, Atlanta, Georgia, USA; †World Health Organization, Geneva, Switzerland; ‡Korean Institute of Tuberculosis, Seoul, Republic of Korea; §National Institute of Infectious Diseases, Buenos Aires, Argentina; ¶Institut Pasteur d’Algérie, Alger, Algeria; #Hospital Universitaris Vall d’Hebron, Barcelona, Spain; **Health Protection Agency, London, United Kingdom; ††Prince Charles Hospital, Brisbane, Queensland, Australia; ‡‡National Institute of Public Health, Scrobarova, Czech Republic; §§Institute of Public Health of Chile, Providencia Santiago, Chile; ¶¶Institute of Medical and Veterinary Science, Adelaide, South Australia, Australia; ##Institute of Tropical Medicine, Antwerp, Belgium; ***National Institute of Health, Porto, Portugal; †††National Reference Center for Mycobacteria, Borstel, Germany; ‡‡‡Institut Pasteur, Paris, France; 1Current affiliation: Albert Einstein College of Medicine, Bronx, New York, USA; 2Member: World Health Organization/International Union against Tuberculosis and Lung Diseases Network of Supranational Reference Laboratories

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Table 1

First-line–drug resistance patterns for Mycobacterium tuberculosis isolates, 2000–2004 (N = 17,690)*

PatternOther 13 SRLs (n = 5,751)Republic of Korea SRL (n = 11,939)
No. testedNo. (%) resistantNo. testedNo. (%) resistant
Any resistance (total)*†‡5,7513,765 (65.5)11,9392,508 (21.0)
INH5,6453,305 (58.5)11,9392,196 (18.4)
RIF5,6492,345 (41.5)11,9391,469 (12.3)
EMB5,5081,356 (24.6)11,939988 (8.3)
SM5,6182,581 (45.9)11,939578 (4.8)
Monoresistance (total)§¶5,751884 (15.4)11,939952 (8.0)
INH5,645456 (8.1)11,939666 (5.6)
RIF5,64999 (1.8)11,939148 (1.2)
EMB5,5088 (0.1)11,93925 (0.2)
SM5,618321 (5.7)11,939113 (0.9)
Polyresistance, non-MDR (total)¶5,644651 (11.5)11,939258 (2.2)
INH + other drugs (except RIF)5,645627 (11.1)11,939232 (1.9)
RIF + other drugs (except INH)5,64924 (0.4)11,93923 (0.2)
Multidrug resistance (total)¶#5,6442,222 (39.4)11,9391,298 (10.9)
INH + RIF, only5,644**399 (7.1)11,939392(3.3)
INH + RIF + EMB, only5,508**182 (3.3)11,939584 (4.9)
INH + RIF + SM, only5,618**619 (11.0)11,93989 (0.7)
INH + RIF + EMB + SM5,476**1,017 (18.6)11,939233 (2.0)

*SRLs, Supranational Reference Laboratories; INH, isoniazid; RIF, rifampin; EMB, ethambutol; SM, streptomycin.
†Missing data for INH (106 isolates), RIF (102 isolates), EMB (243 isolates), SM (133 isolates).
‡Cells are not mutually exclusive.
§Numerator is isolates with resistance to the specified drug and no known resistance to other first-line drugs. Denominator is isolates tested to at least the specified drug in the numerator.
¶Each cell is mutually exclusive.
#Denominator is isolates tested for at least INH + RIF.
**Denominator is isolates tested for at least the drugs in the specified combination.

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