title: Anti-tuberculosis drug resistance in community and prison patients, Orel Oblast, Russian Federation.
abstract: METHODS
  Orel Oblast, Russian Federation.
  
  
  OBJECTIVE
  To determine baseline levels of anti-tuberculosis drug resistance in Orel Oblast.
  
  
  METHODS
  Drug susceptibility testing (DST) records from 1 July 1999 to 30 June 2000 for patients with sputum acid-fast bacilli smear-positive pulmonary tuberculosis were reviewed. Treatment and incarceration status were obtained from the tuberculosis register. Patients with 1 month or less of prior treatment were defined as new cases; those previously treated for more than 1 month were defined as retreatment cases.
  
  
  RESULTS
  Of 246 smear-positive isolates, 212 (86%) had DST performed. Of these, 190 (90%) were from new and 22 (10%) from retreatment cases; 171 (81%) were from community and 41 (19%) were from prison patients. Any drug resistance was more common among prison than community patients (44% vs. 30%, P = 0.05). MDR-TB was found in 14 (6.6%) of 212 isolates, and was more prevalent in prison compared with community patients (12% vs. 5%, P = 0.05). Retreatment cases were more likely than new cases to have MDR-TB (prevalence ratio [PR] = 8.5, 95%CI = 3.3-22.3), although the PR was higher for prison than for community retreatment cases (10.0 vs. 5.8).
  
  
  CONCLUSIONS
  New cases with MDR-TB were less prevalent in Orel Oblast compared with other survey sites in Russia. Any drug resistance and MDR-TB were associated with prior treatment, especially in the prison population. Continued monitoring of trends in drug resistance following DOTS implementation is needed.
authors.affiliation: Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. pps9@cdc.gov
authors.forename: P
authors.initials: P
authors.lastname: Spradling
authors.forename: E
authors.initials: E
authors.lastname: Nemtsova
authors.forename: T
authors.initials: T
authors.lastname: Aptekar
authors.forename: M
authors.initials: M
authors.lastname: Shulgina
authors.forename: L
authors.initials: L
authors.lastname: Rybka
authors.forename: C
authors.initials: C
authors.lastname: Wells
authors.forename: G
authors.initials: G
authors.lastname: Aquino
authors.forename: H
authors.initials: H
authors.lastname: Kluge
authors.forename: W
authors.initials: W
authors.lastname: Jakubowiak
authors.forename: N
authors.initials: N
authors.lastname: Binkin
authors.forename: B
authors.initials: B
authors.lastname: Kazeonny
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000494:pharmacology*; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests / Q000706:statistics & numerical data; D009169:Mycobacterium tuberculosis / Q000187:drug effects*; D011329:Prisoners; D012189:Retrospective Studies; D012426:Russia; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000453:epidemiology*
chemical_list: D000995:Antitubercular Agents