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Published on: August 11, 2008
Pediatric drug-resistant tuberculosis in Madrid: family matters
Begoña Santiago1, Fernando Baquero-Artigao, Asunción Mejías
1From the *Paediatric Infectious Diseases Unit, Gregorio Marañón Hospital; †Molecular ImmunoBiology Laboratory, Health Reseach Institute Gregorio Marañón (IiSGM), Madrid, Spain; ‡Paediatric Infectious Diseases Unit, La Paz Hospital, Madrid, Spain; §Division of Paediatric Infectious Diseases, Center for Vaccines and Immunity, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH; ¶Immunodeficiency Unit, 12 de Octubre University Hospital; ‖Mycobacterial Laboratory, National Centre of Microbiology and **Paediatrics Department, Carlos III Hospital, Madrid, Spain.
Insights
Pediatric tuberculosis (TB) drug resistance, including isoniazid (INH) and multidrug-resistant (MDR) strains, was higher in children born to foreign parents in Spain. This highlights the need for targeted surveillance and guidelines for resistant TB in this population.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Tuberculosis (TB) drug resistance rates vary across Europe, with limited data on pediatric cases in low-endemic countries like Spain.
- Reported rates of isoniazid (INH) resistance and multidrug-resistant (MDR) TB in Spanish adults are 4.9% and 1.3%, respectively.
- Scarce data exists on pediatric TB resistance patterns, necessitating research to inform age-specific guidelines.
Purpose of the Study:
- To determine the incidence of pediatric-resistant TB in the Madrid region.
- To identify risk factors associated with isoniazid (INH) and multidrug-resistant (MDR) TB in children.
- To inform the development of age-targeted guidelines for pediatric TB treatment.
Main Methods:
- A multicenter, retrospective study was conducted across 22 hospitals in the Madrid region (EREMITA study group) from January 2005 to June 2010.
- Medical records of children diagnosed with TB were reviewed for demographic, clinical, and outcome data.
- Risk factors for INH and MDR TB were analyzed.
Main Results:
- Of 396 children with TB, 9.6% (18/188) had INH resistance and 3.1% (6/188) had MDR TB.
- INH resistance and MDR TB were more prevalent in children born to foreign parents (11.9% and 4.5%, respectively) compared to native families (0%; P=0.013 for INH).
- Extrapulmonary TB, previous treatment, and immunosuppression were identified as significant risk factors for drug-resistant TB.
Conclusions:
- Pediatric TB drug resistance rates, specifically for INH and MDR strains, differ based on parental origin, with higher rates observed in children of foreign-born parents.
- Local surveillance of drug-resistant TB is crucial for developing effective treatment guidelines tailored to pediatric populations.
- Findings underscore the importance of considering demographic factors in managing pediatric TB resistance.
Background:
The rates of isoniazid (INH) and multidrug-resistant (MDR) tuberculosis (TB) among European children vary between 10.4% and 3.5%. Spain is a low endemic country with reported rates of 4.9% of INH resistance and 1.3% of MDR in adults. However, data regarding patterns of TB resistance in children are scarce. Our aim is to determine the incidence and risk factors for pediatric-resistant TB in our setting to help developing age-targeted guidelines.
Methods:
A multicenter, retrospective study including 22 hospitals from Madrid region (EREMITA study group) was performed from January 2005 to June 2010. Medical records from children diagnosed with TB were reviewed for demographic characteristics, clinical presentation and outcomes. Risk factors for INH and MDR TB were identified.
Results:
Of 396 children diagnosed with TB, 72.4% were born to foreign parents. Microbiologic confirmation by culture (n = 200) or PCR (n = 8) was documented in 208 children (52.5%). Drug susceptibility results were available in 188 children: 9.6% (n = 18) were resistant to INH and 3.1% (n = 6) were MDR. INH resistance was more common in immigrants compared with native families (11.9% vs. 0%; P = 0.013), as was also MDR (4.5% vs. 0%; P = 0.34). Extrapulmonary TB and previous antituberculous treatment were significantly associated with INH and MDR, while immunosuppression was associated only with MDR.
Conclusions:
The rates of INH and MDR TB were different according to the parents' origin, with higher rates among children born to foreign parents. Local surveillance of drug-resistant TB is critical to develop appropriate guidelines for treatment.
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