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Volume 21, Number 3—March 2015
Research

Multidrug-Resistant Tuberculosis in Europe, 2010–2011

Gunar Günther, Frank van Leth, Sofia Alexandru, Neus Altet, Korkut Avsar, Didi Bang, Raisa Barbuta, Graham Bothamley, Ana Ciobanu, Valeriu Crudu, Manfred Davilovits, Martin Dedicoat, Raquel Duarte, Gina Gualano, Heinke Kunst, Wiel de Lange, Vaira Leimane, Cecile Magis-Escurra, Anne-Marie McLaughlin, Inge Muylle, Veronika Polcová, Emanuele Pontali, Christina Popa, Rudolf Rumetshofer, Alena Skrahina, Varvara Solodovnikova, Victor Spinu, Simon Tiberi, Piret Viiklepp, Christoph LangeComments to Author , and TBNET
Author affiliations: University of Namibia School of Medicine, Windhoek, Namibia (G. Günther, C. Lange); German Center for Infection Research, Research Center Borstel, Borstel, Germany (G. Günther, C. Lange); University of Amsterdam, Amsterdam, the Netherlands (F. van Leth); Institute of Phthisiopneumology, Chisinau, Moldova (S. Alexandru, A. Ciubanu, V. Crudu); Hospital Universitari Vall d’Hebron, Barcelona, Spain (N. Altet); Jordi Gol University, Barcelona (N. Altet); Asklepios Klinik Gauting, Gauting, Germany (K. Avsar); Statens Serum Institut, Copenhagen, Denmark (D. Bang); Herlev Hospital, Herlev, Denmark (D. Bang); Balti Municipal Hospital, Balti, Moldova (R. Barbuta); Homerton University Hospital, London, UK (G. Bothamley); National TB Reference Laboratory, Chisinau, Moldova (V. Crudu); Tartu University Lung Hospital, Tartu, Estonia (M. Danilovits); University of Warwick, Coventry, UK (M. Dedicoat); Heart of England Foundation Trust, Birmingham, UK (M. Dedicoat, H. Kunst); Vila Nova de Gaia/Espinho Medical School, Vila Nova de Gaia, Portugal (R. Duarte); Porto University, Porto, Portugal (R. Duarte); National Institute for Infectious Diseases L. Spallanzani, Rome, Italy (G. Gualano); Queen Mary University, London (H. Kunst); University Medical Center Groningen, Groningen, the Netherlands (W. de Lange); Riga East University Hospital, Riga, Latvia (V. Leimane); Radboud University Medical Centre, Nijmegen/Groesbeek, the Netherlands (C. Magis-Escurra); St. James's Hospital, Dublin, Ireland (A.-M. McLaughlin); University Medical Center St. Pieter, Brussels, Belgium (I. Muylle); Thomayer University Hospital, Prague, Czech Republic (V. Polcavá); Galliera Hospital, Genoa, Italy (E. Pontali); Marius-Nasta-Institut, Bucharest, Romania (C. Popa, V. Spinu); Otto Wagner Hospital, Vienna, Austria (R. Rumetshofer); Republican Research and Practical Centre for Pulmonology and Tuberculosis, Minsk, Belarus (A. Skrahina, Varvara Solodovnikova); Azienda Ospedaliera della Valtellina e della Valchiavenna E. Morelli Reference Hospital for MDR and HIV-TB, Sondalo, Italy (S. Tiberi); Barts Health National Health Service Trust, London (S. Tiberi); National Institute for Health Development, Tallinn, Estonia, (P. Viiklepp); Karolinska Institute, Stockholm, Sweden (C. Lange)

Main Article

Table 1

Baseline characteristics of patients with MDR TB in TBNET study in Europe, 2010–2011*

Characteristic Incidence of TB
All sites
Low† Intermediate‡ High§
Patients 103 (27.1) 86 (22.6) 191 (50.3) 380 (100)
Age, y 31 (27–39) 41 (26–49) 37 (28–50) 36 (27–47)
Body mass index 20 (19–23) 21 (18–22) 21 (18–23) 21 (19–23)
Male sex 50 (48.5) 56 (65.1) 133 (69.6) 239 (62.9)
Foreign born 88 (85.4) 5 (5.8) 1 (0.5) 94 (24.7)
Current smoker
Yes 65 (63.1) 33 (38.4) 94 (49.2) 192 (50.5)
Unknown 9 (8.7) 2 (2.3) 1 (0.5) 13 (3.4)
HIV infected
Yes 8 (7.8) 8 (9.3) 9 (4.7) 25 (6.6)
Not tested 8 (7.8) 0 1 (0.5) 9 (2.4)
Unknown 0 0 1 (0.5) 1 (0.3)
Diabetes
Yes 3 (2.9) 4 (4.7) 9 (4.7) 16 (4.2)
Unknown 5 (4.9) 2 (2.3) 1 (0.5) 8 (2.1)
TB contact
No 49 (47.6) 39 (45.3) 68 (35.6) 156 (41.1)
Yes, no MDR case 1 (1.0) 16 (18.6) 23 (12.0) 54 (14.2)
Yes, MDR case 15 (14.6) 2 (2.3) 5 (2.6) 8 (2.1)
Unknown 38 (36.9) 29 (33.7) 95 (49.7) 162 (42.6)
TB treatment
Yes 42 (40.8) 23 (26.7) 116 (60.7) 181 (47.6)
Unknown 3 (2.9) 0 0 3 (0.8)
Classification of current TB episode
New 61 (59.2) 64 (74.4) 74 (38.7) 199 (52.4)
Relapse 23 (22.3) 20 (23.3) 48 (25.1) 91 (23.9)
Treatment failure 8 (7.8) 2 (2.3) 37 (19.4) 47 (12.4)
Chronic 1 (1.0) 0 14 (7.3) 15 (3.9)
Returned defaulter 9 (8.7) 0 18 (9.4) 27 (7.1)
Unknown 1 (1.0) 0 0 1 (0.3)
Location of TB infection
Pulmonary 74 (71.8) 79 (91.9) 191 (100.0) 344 (90.5)
Extrapulmonary 14 (13.6) 2 (2.3) 0 16 (4.2)
Pulmonary and extrapulmonary 15 (14.6) 5 (5.8) 0 20 (5.3)
Radiologic findings
No pathologic changes 8 (7.8) 1 (1.2) 1 (0.5) 10 (2.6)
Cavitary 40 (38.8) 52 (60.5) 147 (77.0) 239 (62.9)
Noncavitary 52 (50.5) 33 (38.4) 43 (22.5) 128 (33.7)
Unknown 3 (2.9) 0 0 3 (0.8)
Bacteriologic result
Smear +, culture + 64 (62.1) 39 (45.3) 142 (74.3) 245 (64.5)
Smear –, culture + 38 (36.9) 45 (52.3) 47 (24.6) 130 (34.2)
Unknown 1 (1.0) 0 0 1 (0.3)
Age, y
<18 3 (2.9) 0 6 (3.1) 9 (2.4)
18–24 17 (16.5) 14 (16.3) 25 (13.1) 56 (14.7)
25–44 68 (66.0) 34 (39.5) 91 (47.6) 193 (50.8)
45–64 12 (11.7) 28 (32.6) 62 (32.5) 102 (26.8)
≥65 3 (2.9) 2 (2.3) 2 (1.0) 7 (1.8)
Unknown 0 8 (9.3) 5 (2.6) 13 (3.4)
Currently employed
Yes 46 (44.7) 35 (40.7) 63 (33.3) 144 (37.9)
Unknown 7 (6.8) 6 (7.0) 1 (0.5) 14 (3.7)
Work in a high-risk setting for TB
Yes 8 (7.8) 6 (7.0) 9 (4.7) 23 (6.1)
Unknown 16 (15.5) 12 (14.0) 107 (56.0) 135 (35.5)
Excessive alcohol consumption
Yes 11 (10.7) 20 (23.3) 48 (25.1) 79 (20.8)
Unknown 10 (9.7) 1 (1.2) 1 (0.5) 12 (3.2)
Imprisonment before current diagnosis
Yes 4 (3.9) 8 (9.3) 18 (9.4) 30 (7.9)
Unknown 12 (11.7) 1 (1.2) 1 (0.5) 14 (3.7)
Current homelessness
Yes 9 (8.7) 2 (2.3) 5 (2.6) 16 (4.2)
Unknown 2 (1.9) 2 (2.3) 1 (0.5) 5 (1.3)
Injectable drug use
Yes 7 (6.8) 7 (8.1) 10 (5.2) 24 (6.3)
Unknown 12 (11.7) 2 (2.3) 15 (7.9) 29 (7.6)
Hepatitis B
Yes 14 (13.6) 2 (2.3) 1 (0.5) 17 (4.5)
Unknown 20 (19.4) 5 (5.8) 78 (40.8) 103 (27.1)
Hepatitis C
Yes 12 (11.7) 5 (5.8) 2 (1.0) 19 (5.0)
Unknown 22 (21.4) 22 (25.6) 81 (42.4) 125 (32.9)
Use of TNF inhibitor
Yes 1 (1.0) 0 4 (2.1) 5 (1.3)
Unknown 7 (6.8) 5 (5.8) 42 (22.0) 54 (14.2)
Silicosis
Yes 0 1 (1.2) 0 1 (0.3)
Unknown 3 (2.9) 1 (1.2) 1 (1.1) 5 (1.3)
Vaccination with Mycobacterium bovis BCG
Yes 42 (40.8) 72 (83.7) 184 (96.3) 300 (78.5)
Unknown 58 (56.3) 14 (16.3) 6 (3.1) 78 (20.4)

*Values are no. (%) or median (interquartile range). Unweighted analysis was used. MDR TB, multidrug-resistant tuberculosis; +, positive; –, negative;TNF, tumor necrosis factor.
†Austria, Belgium, Czech Republic, Denmark, Germany, Great Britain, Ireland, Netherlands, Italy, and Spain.
‡Belarus, Estonia, Latvia, and Portugal.
§Moldova and Romania.

Main Article

1Additional contributors from TBNET are listed at the end of this article.

Page created: February 18, 2015
Page updated: February 18, 2015
Page reviewed: February 18, 2015
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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