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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 F. 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 3

Second-line–drug resistance patterns for multidrug-resistant Mycobacterium tuberculosis isolates, 2000–2004*†‡

PatternNo. testedNo. (%) resistant
Any resistance (total)3,5201,542 (43.8)
Aminoglycosides (AG)§3,442630 (18.3)
Capreomycin (CM)2,743279 (10.2)
Fluoroquinolones (FQ)3,492673 (19.3)
Thioamides (TA)3,132605 (19.3)
Cycloserine (CS)2,615141 (5.4)
Para-aminosalicylic acid (PAS)2,860450 (15.7)
Extensively drug-resistant TB (XDR-TB, total)¶3,520347 (9.9)
AG + CM + FQ2,65690 (3.4)
AG + CM + TA2,49877 (3.1)
CM + FQ + TA26050 (19.2)
AG + FQ + TA3,040102 (3.4)
AG + FQ + CS13939 (28.1)
FQ + TA + PAS2,50594 (3.8)

*Tested for ≥3 second-line drug classes; SRLs, Supranational Reference Laboratories.
†Not all isolates were tested for each second-line drug class (with the exception of the Republic of Korea SRL), so results are reported as a proportion of isolates tested to the specified class of drugs. For combination resistance patterns, results are reported as a proportion of isolates tested to all of the classes of drugs in the specific combination.
‡Cells are not mutually exclusive.
§Other than streptomycin (e.g., kanamycin, amikacin).
¶XDR-TB, extensively drug-resistant tuberculosis, i.e., multidrug-resistant tuberculosis (resistant to at least isoniazid and rifampin) with additional resistance to ≥3 classes of second-line drugs.

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