Extensively drug-resistant tuberculosis in the UK: 1995 to 2007
- I Abubakar1,
- J Moore1,
- F Drobniewski1,
- M Kruijshaar1,
- T Brown1,
- M Yates1,
- C Anderson1,
- E G Smith2,
- J Magee3,
- M Lipman4,
- J McMenamin5,
- M Ruddy6,
- J M Watson1
- 1Respiratory and Systemic Infections Department, Centre for Infections, Health Protection Agency, London, UK
- 2Health Protection Agency Regional Centre for Mycobacteriology, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham, UK
- 3Health Protection Agency Regional Centre for Mycobacteriology, General Hospital, Westgate Road, Newcastle upon Tyne, UK
- 4Royal Free Hospital NHS Trust, Pond Street London, UK
- 5Health Protection Scotland, Glasgow, UK
- 6Wales Centre for Mycobacteriology, Llandough Hospital, Penlan Road, Penarth, UK
- Dr I Abubakar, Tuberculosis Section, Respiratory and Systemic Infections Department, Centre for Infections, Health Protection Agency, London NW9 5EQ;
- Received 26 September 2008
- Accepted 7 February 2009
- Published Online First 23 March 2009
Background: The emergence of multidrug-resistant tuberculosis (MDRTB) and extensively drug-resistant tuberculosis (XDRTB) is a threat to global tuberculosis control. Limited information is, however, available on the outcome of XDRTB cases. This study describes the susceptibility to second- and third-line antituberculosis drugs among MDRTB cases and treatment outcome of identified XDRTB cases.
Method: The results of second-line antituberculosis drug susceptibility tests in the UK between January 1995 and December 2007 were retrospectively reviewed and clinicians contacted for treatment outcome of XDRTB cases. Participants included all 678 patients with culture-confirmed MDRTB in the UK. The main outcome measures were the proportion of isolates resistant to second-line antituberculosis drugs and treatment outcome for XDRTB cases.
Results: Among MDRTB isolates, levels of resistance to amikacin, capreomycin, ciprofloxacin, cycloserine, ethionamide and p-aminosalicylic acid (PAS) were 5.5, 3.4, 5.6, 5.1, 14.0 and 16.7%, respectively. Six XDRTB cases (0.9% of MDR cases) were identified during this period. Two further cases of XDRTB were reported in 2008. Five individuals with XDRTB died of tuberculosis within 3 years of diagnosis and three are still on treatment.
Conclusion: Levels of MDRTB remain low, and those of XDRTB very low, in this high income country. The case fatality ratio among XDRTB cases was high despite low levels of HIV co-infection.
Competing interests: None.
Ethics approval: The Health Protection Agency has Patient Information Advisory Group approval to hold and analyse national surveillance data for public health purposes under Section 60 of the Health and Social Care Act 2001.