Multidrug-resistant tuberculosis: eight years of surveillance in France

The aim of this study was to evaluate the annual prevalence of multidrug-resistant tuberculosis (MDRTB) and to describe the characteristics of the patients with MDRTB in France. Annual questionnaire surveys from 1992-1999 were mailed to all French microbiological laboratories performing mycobacterial cultures. A total of 264 distinct patients were reported to the National Reference Centre for Resistance of Mycobacteria to Antituberculosis Drugs during the 8-yr surveillance period resulting in a mean annual prevalence of MDRTB of 0.6%. A mean of 16% of the MDRTB patients were reported over several subsequent years. The majority of patients were male (69.7%), foreign-born (55.7%), with a previous history of treatment (65.9%), and pulmonary involvement (92.8%) with smear-positive results (59.1%). Human immunodeficiency virus (HIV) coinfection was present in 20.8% of the patients. Strains were resistant only to isoniazid and rifampin in 37.9% of the cases, and additional resistance to both streptomycin and ethambutol was present in 25.8%. HIV coinfection and female status were statistically associated with primary resistance, whereas smear-positive results were associated with secondary resistance. Foreign-birth and smear-positive results were associated with a chronic status. The prevalence of multidrug-resistant tuberculosis is low in France (<1%). However, a substantial proportion of patients remain positive for several years, suggesting nonoptimal management. Therefore, as recommended by the World Health Organization, a few reference teams, working in collaboration with national associations of physicians and microbiologists, should be established to improve the outcome of multidrug-resistant tuberculosis.