Below: TBNET study sites in the Pan European network for study and clinical management of drug-resistant tuberculosis (TBPAN-NET) project. Stratification is based on the incidence of tuberculosis (TB) reported during 2010–2011, which matched the inclusion period of the study. Data for 2011 were obtained from the European Centre for Disease Control and Prevention (10). Low TB incidence, <20 cases/100,000 persons; intermediate TB incidence, 20–100 cases/100,000 persons; high TB incidence, >100 cases/100,000 persons.
Drug-resistant Mycobacterium tuberculosis is challenging elimination of tuberculosis (TB). We evaluated risk factors for TB and levels of second-line drug resistance in M. tuberculosis in patients in Europe with multidrug-resistant (MDR) TB. A total of 380 patients with MDR TB and 376 patients with non–MDR TB were enrolled at 23 centers in 16 countries in Europe during 2010–2011. A total of 52.4% of MDR TB patients had never been treated for TB, which suggests primary transmission of MDR M. tuberculosis. At initiation of treatment for MDR TB, 59.7% of M. tuberculosis strains tested were resistant to pyrazinamide, 51.1% were resistant to ≥1 second-line drug, 26.6% were resistant to second-line injectable drugs, 17.6% were resistant to fluoroquinolones, and 6.8% were extensively drug resistant. Previous treatment for TB was the strongest risk factor for MDR TB. High levels of primary transmission and advanced resistance to second-line drugs characterize MDR TB cases in Europe.
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