Comparative study of antituberculous drug resistance among Mycobacterium tuberculosis isolates recovered at the American University of Beirut Medical Center: 1996-1998 vs 1994-1995.
OBJECTIVE
To study the overall current prevalence of antituberculous drug resistance among M. tuberculosis isolates recovered at the American University of Beirut Medical Center (AUBMC) between 1996-1998 in comparison to those reported on isolates recovered in 1994-1995.


METHODS
Seventy-four consecutive M. tuberculosis isolates recovered from the same number of newly diagnosed cases of tuberculosis (TB), between January 1996 and December 1998 (referred to as 1998), were tested against isoniazid (INH), rifampicin (RIF), streptomycin (STM) and ethambutol (ETH), using the BACTEC-TB susceptibility procedure and system. The results were compared to those reported on the isolates recovered in 1994-1995 (referred to as 1995).


RESULTS
A comparison between the results obtained in 1998 vs 1995 showed the following, respectively: The male to female ratio was 3.1:1 vs 2:1 and the mean ages were almost similar in males, 33.4 vs 34.1 years but were slightly higher in females 38.2 vs 32.7 years. Children (< or = 15 yrs) represented 10.8% vs 8.3% of the study population. The prevalence of resistance, to one or more drugs, was almost the same, 24% vs 26% but the overall percentages of single drug resistance were generally higher in 1998 vs 1995 against all the tested drugs except INH: INH (20.2% vs 23.9%), RIF (16.2% vs 12.5%), STM (13.5% vs 7.3%) and ETH (8.1% vs 3%). Among the resistant isolates, the profiles of resistance indicated decrease in resistance to one and two drugs, 6.7% vs 11.5% and 5.4% vs 10.4%, respectively, but showed increase in resistance to three and four drugs, 8.1% vs 2.1% and 4% vs 2.1%, respectively. Increase in resistance to two or more drugs was also observed, 17.6% vs 14.6%, and the prevalence of multidrug resistance, defined as resistance to at least both INH and RIF, was also increased, 14.7% vs 11.4%.


CONCLUSIONS
This study shows a high prevalence and persistence of TB drug resistance tested in our Medical Center in Lebanon. In addition, the shift in the increase of resistance from one and two drugs to three and four drugs are very ominous and should be considered when treating patients in this country. Moreover, such information calls for scrutinizing the existing local TB control programs as part of the global efforts to minimize the incidence of this highly morbid infectious disease.
Araj
G F
GF
Department of Pathology & Laboratory Medicine, American University of Beirut Medical Center (AUBMC), Lebanon. garaj@aub.edu.lb
Itani
L Y
LY
Kanj
N A
NA
Jamaleddine
G W
GW
D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007861:Lebanon; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects*; D014376:Tuberculosis / Q000188:drug therapy* / Q000382:microbiology; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000382:microbiology
D000995:Antitubercular Agents