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Extensively drug resistant tuberculosis in the United Kingdom: 1995 to 2007
  1. Ibrahim Abubakar (ibrahim.abubakar{at}hpa.org.uk)
  1. Health Protection Agency, United Kingdom
    1. Jonathan Moore
    1. Health Protection Agency Centre for Infections, United Kingdom
      1. Francis Drobniewski
      1. Health Protection Agency Centre for Infections, United Kingdom
        1. Michelle Kruijshaar
        1. Health Protection Agency Centre for Infections, United Kingdom
          1. Timothy Brown
          1. Health Protection Agency Centre for Infections, United Kingdom
            1. Malcolm Yates
            1. Health Protection Agency Centre for Infections, United Kingdom
              1. Charlotte Anderson
              1. Health Protection Agency Centre for Infections, United Kingdom
                1. E Grace Smith
                1. Health Protection Agency Midlands Mycobacteriology Reference Laboratory, United Kingdom
                  1. John Magee
                  1. Health Protection Agency Regional Centre for Mycobacteriology Newcastle, United Kingdom
                    1. Marc Lipman
                    1. Royal Free Hospital, United Kingdom
                      1. Jim McMenamin
                      1. Health Protection Scotland, United Kingdom
                        1. Michael Ruddy
                        1. Wales Centre for Mycobacteriology, Cardiff, United Kingdom
                          1. John M Watson
                          1. Health Protection Agency Centre for Infections, United Kingdom

                            Abstract

                            Background: The emergence of multi-drug 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 anti-tuberculosis drugs among MDRTB cases and treatment outcome of identified XDRTB cases.

                            Method: Results of second line anti-tuberculosis 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 anti-tuberculosis drugs and treatment outcome for XDRTB cases.

                            Results: Among MDRTB isolates, levels of resistance to amikacin, capreomycin, ciprofloxacin, cycloserine, ethionamide and 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 XDR very low, in this high income country. Case fatality ratio among XDRTB cases was high despite low levels of HIV co-infection.

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