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Vol. 37. Issue 9.
Pages 574-579 (November 2019)
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Vol. 37. Issue 9.
Pages 574-579 (November 2019)
Original article
DOI: 10.1016/j.eimce.2019.01.007
Low antimicrobial resistance rates of Mycobacterium tuberculosis complex between 2000 and 2015 in Gipuzkoa, northern Spain
Baja tasa de resistencia antibiótica de Mycobacterium tuberculosis complex en Gipuzkoa, norte de España, entre 2000 y 2015
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Diego Vicentea,b,c,
Corresponding author
, Mikel Basterretxead,e, Idoia de la Cabaa, Rosa Sanchod, Maddi López-Olaizolaa, Gustavo Cillaa,b
a Departmento de Microbiología, Hospital Universitario Donostia, Donostia-San Sebastián, Spain
b Biomedical Research Center Network for Respiratory Diseases (CIBERES), Madrid, Spain
c Departamento de Medicina Preventiva y Salud Pública, Universidad del País Vasco, Leioa, Spain
d Departmento de Salud del Gobierno Vasco, Subdirección de Salud Pública de Gipuzkoa, Donostia-San Sebastián, Spain
e Biomedical Research Center Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Tables (4)
Table 1. Antimicrobial susceptibility of 1855 strains of Mycobacterium tuberculosis complex in Gipuzkoa, north of Spain, between 2000 and 2015.
Table 2. Factors associated with resistance to tuberculous drugs in 1855 episodes of TB in Gipuzkoa, north of Spain, between 2000 and 2015.
Table 3. Resistance to tuberculosis drugs by geographical area among the population resident in Gipuzkoa, north of Spain, between 2000 and 2015.
Table 4. Characteristics of nine multidrug-resistant tuberculosis (MDR-TB) cases detected in Gipuzkoa, north of Spain between 2000 and 2015.
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Abstract
Objective

Although the incidence of tuberculosis (TB) has declined, TB drug resistance remains a major problem. The TB rate in Gipuzkoa (northern Spain) is higher than the European average. The objective of this study was to determine the antimicrobial susceptibility of 1855 Mycobacterium tuberculosis complex isolates (94.5% of confirmed cases between 2000 and 2015).

Methods

Susceptibility testing was performed using the agar proportion method and a commercial broth system (MGIT 960). In isoniazid- or rifampicin-resistant strains, we studied genetic determinants of drug resistance and genotype (MIRU-VNTR).

Results

The annual mean incidence of TB was 24.5 cases per 100,000 population on average, and tended to decrease. The multidrug-resistant TB rate was 0.5% (9/1855), and no extensively drug-resistant TB strains were detected. Rates of resistance to isoniazid and rifampicin were 3.9% (range, 3.4–4.3%) and 0.6% (range, 0.4–1.4%), respectively. TB resistance was more common among foreign-born individuals and those who had received previous TB treatment. Genotyping of 102 resistant strains showed predominance of the Euro-American lineage, although 4/9 multidrug-resistant strains had Eastern lineages (2 East African-Indian, and 2 East Asian [Beijing]).

Conclusions

In Gipuzkoa, with a moderate incidence of TB, resistance was very low, mostly being detected among individuals who were born abroad or who had a history of TB treatment.

Keywords:
Drug-resistant tuberculosis
Multidrug-resistant tuberculosis
Microbial sensitivity test
Epidemiology
Resumen
Objetivo

Aunque la incidencia de tuberculosis (TB) está descendiendo, la resistencia a fármacos antituberculosos continúa siendo un grave problema. Gipuzkoa, norte de España, tiene una tasa de TB superior a la media europea. El objetivo de este trabajo fue estudiar la sensibilidad a los antibióticos de 1.855 aislamientos de Mycobacterium tuberculosis complex (94,5% de los casos confirmados entre 2000 y 2015).

Métodos

El estudio de susceptibilidad se realizó mediante el método de las proporciones en agar, y mediante dilución en caldo (sistema MGIT 960). En las cepas resistentes a isoniacida o rifampicina se analizaron determinantes genéticos de resistencia y el genotipo (MIRU-VNTR).

Resultados

La incidencia media anual de TB fue de 24,5 casos por 100.000 habitantes, con una tendencia decreciente. La tasa de multirresistencia fue del 0,5% (9/1.855), y no se detectaron cepas con resistencia extrema. Las tasas de resistencia a isoniacida y rifampicina fueron del 3,9% (rango: 3,4-4,3%) y 0,6% (rango: 0,4-1,4%), respectivamente. La TB resistente fue más frecuente entre las personas nacidas en el extranjero y entre los que recibieron tratamiento antituberculoso previo. El genotipado de 102 cepas resistentes mostró predominio del linaje Euro-Americano, aunque 4/9 cepas multirresistentes pertenecieron a linajes orientales (2 East African-Indian, y 2 East Asian [Beijing]).

Conclusiones

En Gipuzkoa, con una incidencia moderada de TB, la resistencia fue muy baja, y asociada especialmente a personas nacidas en el extranjero o que recibieron tratamiento antituberculoso previo.

Palabras clave:
Tuberculosis resistente
Tuberculosis multirresistente
Susceptibilidad antibiótica
Epidemiología

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