[Multidrug resistant tuberculosis in Romania in the last years (2004-2007)--an extremely important social phenomenon]

The emergence of resistance to drugs used to treat tuberculosis (TB), and particularly multidrug resistant (MDR-TB) strains, has become a significant public health problem in a number of countries and an obstacle to effective global TB control. In many other countries, the extent of drug resistance is unknown and the management of the patients with MDR-TB is inadequate. In countries where drug resistance has been identified, specific measures need to be taken within TB control programmes to address the problem through appropriate management of patients and adoption of strategies to prevent the propagation and dissemination of drug resistant TB, including MDR-TB. In Romania there are two centers for the management of MDR-TB cases: one in Bucharest at The National Pneumology Institute "Marius Nasta" and the other at Bisericani (Neamt district). The comparative analysis of MDR-TB cases and under treatment evolution was done, in the two excellence centers Bucharest and Bisericani from 2004 to 2007. This is a retrospective study of MDR-TB patients enrolled in Romania between 2004-2007. All patients evaluated were managed under The National Tuberculosis Programme approved protocols and had the opportunity to receive more than 24 months of treatment. In addition, follow-up data on successfully treated patients were collected at the beginning of 2007. This study is based on an MDR register, and a software collecting information on MDR-TB cases. In order to be accepted in one of the two MDR centers, patients need to fulfill certain criteria to improve the treatment results. A total number of 305 MDR-TB patients were registered at the beginning of 2007 in Bucharest MDR center; this study used a number of 170 MDR-TB patients from Bucharest who fulfilled the study's criteria in oppose to the 294 MDR-TB patients from Bisericani. 184 patients from the first cohort of DOTS-Plus project were evaluated until the end of the study: 55 were completed treatment and 54 cured, which means 59,23% succes rate. The conversion rate of culture at 4 months (for the first cohort) in MDR excellence centers was: Bucharest--72,5% and Bisericani--64%.