Epidemiology of antituberculosis drug resistance 2002–07: an updated analysis of the global project on anti-tuberculosis drug resistance surveillance.

Wright, A.; Zignol, M.; Van Deun, A.; Falzon, D.; Gerdes, S.R.; Feldman, K.; Hoffner, S.; Drobniewski, F.; Barrera, L.; van Soolingen, D.; Boulabhal, F.; Paramasivan, C.N.; Kam, K.M.; Mitarai, S.; Nunn, P.; Raviglione, M.; for the Global Project on Anti-Tuberculosis Drug Resistance Surveillance.

The Lancet; 2009; 373; 1861-1873.

Summary: Background: The Global Project on Anti-Tuberculosis Drug Resistance has been gathering data since 1994. This study provides the latest data on the extent of drug resistance worldwide.

Methods: Data for drug susceptibility were gathered from 90 726 patients in 83 countries and territories between 2002 and 2007. Standardised collection of results enabled comparison both between and within countries. Where possible, data for HIV status and resistance to second-line drugs were also obtained. Laboratory data were quality assured by the Supranational Tuberculosis Reference Laboratory Network.

Findings: The median prevalence of resistance to any drug in new cases of tuberculosis was 11·1% (IQR 7·0–22·3). The prevalence of multidrug resistance in new tuberculosis cases ranged from 0% in eight countries to 7% in two provinces in China, 11·1% in Northern Mariana Islands (although reporting only two cases), and between 6·8% and 22·3% in nine countries of the former Soviet Union, including 19·4% in Moldova and 22·3% in Baku, Azerbaijan (median for countries surveyed 1·6%, IQR 0·6–3·9). Trend analysis showed that between 1994 and 2007, the prevalence of multidrug-resistant (MDR) tuberculosis in new cases increased substantially in South Korea and in Tomsk Oblast and Orel Oblast, Russia , but was stable in Estonia and Latvia . The prevalence of MDR tuberculosis in all tuberculosis cases decreased in Hong Kong and the USA . 37 countries and territories reported representative data on extensively drug resistant (XDR) tuberculosis. Five countries, all from the former Soviet Union , reported 25 cases or more of XDR tuberculosis each, with prevalence among MDR-tuberculosis cases ranging between 6·6% and 23·7%.

Interpretation: MDR tuberculosis remains a threat to tuberculosis control in provinces in China and countries of the former Soviet Union . Data on drug resistance are unavailable in many countries, especially in Africa , emphasizing the need to develop easier methods for surveillance of resistance in tuberculosis.

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