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Multidrug-resistant tuberculosis in the Florence province from 1992 to 1995
Setting:
Epidemiological data on the frequency of drug-resistant tuberculosis is not available in Italy.
Objectives:
Evaluation of the rate of multidrug-resistant tuberculosis in the Province of Florence, Italy.
Design:
Retrospective analysis of all sensitivity tests performed with the Bactec method on initial mycobacterial isolates, from 1 January 1992 to 31 December 1995, in the Province of Florence.
Results:
The following rates of resistance were found in the 433 samples tested: isoniazid + rifampicin 2.5%, at least one drug 13.8%, isoniazid 10.6%, rifampicin 3.6%, streptomycin 3.6%, pyrazinamide 1.7% and ethambutol 0.6%. Resistance was higher in foreign-born individuals from high prevalence countries than in the Italian-born population, whereas resistance to streptomycin was more frequent in the latter. The yearly rates of resistance showed no significant variation in the period examined. Clinical data were available in 231 patients: the rate of resistance to at least one drug and to isoniazid + rifampicin were 10.8% and 0%, respectively, in never treated patients, and 28.5% and 7.1%, respectively, in previously treated patients.
Conclusion:
These data show higher multidrug resistance rates than those found in other European countries such as England and Wales, France and Switzerland. This result suggests the need to establish official guidelines for the correct treatment of tuberculosis in Italy, in order to prevent the onset of drug resistance, and to establish a national surveillance system for mycobacterial resistance.