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2019-06-12Zeitschriftenartikel DOI: 10.25646/6293
First-line tuberculosis drug resistance patterns and associated risk factors in Germany, 2008-2017
dc.contributor.authorGlasauer, Saskia
dc.contributor.authorAltmann, Doris
dc.contributor.authorHauer, Barbara
dc.contributor.authorBrodhun, Bonita
dc.contributor.authorHaas, Walter
dc.contributor.authorPerumal, Nita
dc.date.accessioned2019-09-20T10:25:30Z
dc.date.available2019-09-20T10:25:30Z
dc.date.issued2019-06-12none
dc.identifier.other10.1371/journal.pone.0217597
dc.identifier.urihttp://edoc.rki.de/176904/6307
dc.description.abstractBackground Drug-resistant tuberculosis (TB), especially multidrug-resistant TB (MDR-TB), poses a threat to public health. While standard surveillance focuses on Rifampicin and/or Isoniazid resistance, little is known about other resistance patterns. This study aims to identify predominant drug resistance (DR) patterns in Germany and risk factors associated with them in order to inform diagnostic and treatment strategies. Methods Case-based TB surveillance data notified in Germany from 2008–2017 were utilized to investigate DR and MDR-TB patterns for Isoniazid (H), Rifampicin (R), Pyrazinamide (Z), Ethambutol (E), and Streptomycin (S). Predominant patterns were further analyzed stratified by sex, age, country of birth, prior TB, and disease site. Multivariable logistic regression was conducted to determine risk factors associated with any resistance, MDR-TB, and complete HRZES resistance. Results 26,228 cases with complete DST results were included in the study, among which 3,324 cases had any DR (12.7%). Four patterns were predominant, representing about ¾ of all cases with any resistance (S: 814 [3.1%]; H: 768 [2.9%]; HS: 552 [2.1%]; Z: 412 [1.6%]). High proportions of S and H resistances were found among both German and foreign-born populations, especially those born in Eastern Europe, and were unexpectedly high among children (H: 4.3%; S: 4.6%). Foreign-born cases had significantly higher proportion of any resistance (16.0%) and MDR-TB (3.3%) compared to German-born cases (8.3% and 0.6%). Of 556 MDR-TB cases, 39.2% showed complete HRZES resistance. Logistic regression revealed having prior TB and being foreign-born as consistently strong risk factors for any DR, MDR-TB, and complete HRZES resistance. Conclusions DR patterns observed in Germany, particularly for MDR-TB were more complex than expected, highlighting the fact that detailed drug-testing results are crucial before incorporating HRZES drugs in MDR-TB treatment. Furthermore, the relatively high rate of H-resistance in Germany provides strong rationale against the use of only H-based preventive therapy for LTBI.eng
dc.language.isoengnone
dc.publisherRobert Koch-Institut
dc.rights(CC BY 3.0 DE) Namensnennung 3.0 Deutschlandger
dc.rights.urihttp://creativecommons.org/licenses/by/3.0/de/
dc.subject.ddc610 Medizin und Gesundheitnone
dc.titleFirst-line tuberculosis drug resistance patterns and associated risk factors in Germany, 2008-2017none
dc.typearticle
dc.identifier.urnurn:nbn:de:kobv:0257-176904/6307-7
dc.identifier.doihttp://dx.doi.org/10.25646/6293
dc.type.versionpublishedVersionnone
local.edoc.container-titlePLoS ONEnone
local.edoc.type-nameZeitschriftenartikel
local.edoc.container-typeperiodical
local.edoc.container-type-nameZeitschrift
local.edoc.container-urlhttps://journals.plos.org/plosone/article?id=10.1371/journal.pone.0217597none
local.edoc.container-publisher-namePublic Library of Sciencenone
local.edoc.container-volume14none
local.edoc.container-issue6none
local.edoc.container-reportyear2019none
local.edoc.container-year2019none
local.edoc.container-firstpage1none
local.edoc.container-lastpage18none
local.edoc.rki-departmentInfektionsepidemiologienone
dc.description.versionPeer Reviewednone

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