Drug-resistant pulmonary tuberculosis in Berlin, Germany, 1987-1993

Area of Science:

• Infectious Diseases
• Microbiology
• Public Health

Background:

• Tuberculosis (TB) drug resistance poses a growing global health challenge.
• Limited public health data exists for urban German populations regarding TB resistance.
• This study addresses the need for local data on TB resistance patterns.

Purpose of the Study:

• To investigate the prevalence and trends of drug resistance in Mycobacterium tuberculosis (M.tb) strains among hospitalized patients in Germany.
• To identify risk factors associated with single-drug resistance (SDR) and multidrug resistance (MDR).

Main Methods:

• Retrospective analysis of clinical data and susceptibility testing results for 1,011 hospitalized patients over seven years (1987-1993).
• Evaluation of resistance to first-line anti-TB drugs: isoniazid, streptomycin, rifampin, pyrazinamide, prothionamide, and ethambutol.
• Statistical analysis to determine risk factors (previous therapy, foreign-born status) for SDR and MDR-TB.

Main Results:

• Single-drug resistance (SDR) remained relatively constant (5.9%), while multidrug resistance (MDR) increased significantly from 1.7% in 1987 to 5.8% in 1993.
• Sixty-nine percent of MDR cases showed resistance to two drugs; 31% to three or more.
• Previous therapy (OR 2.2-4.5) and foreign-born status (OR 2.2-3.5) were significant risk factors for both SDR and MDR-TB.

Conclusions:

• A considerable increase in MDR-TB was observed in the studied German hospital population between 1987 and 1993.
• Patients with prior treatment history and those born in high-resistance prevalence countries are at higher risk.
• Initial four-drug regimens are recommended for high-risk patients to combat emerging drug resistance.