High prevalence of drug-resistant tuberculosis, Republic of Lithuania, 2002.
BACKGROUND
Nations of the former Soviet Union have the world's highest reported levels of resistance to anti-tuberculosis drugs. We conducted the first national survey of anti-tuberculosis drug resistance in the Republic of Lithuania.


METHODS
We tested Mycobacterium tuberculosis isolates from all incident culture-positive pulmonary TB patients registered in 2002. New patients were those treated for <1 month with any first-line anti-tuberculosis drug (isoniazid [INH], rifampin [RMP], ethambutol, or streptomycin); previously treated patients were those treated for > or =1 month.


RESULTS
Of 1163 isolates, 475 (41%) were resistant to at least one first-line drug, and 263 (23%) were resistant to at least INH and RMP (MDR); this included 76/818 (9.3%) from new patients and 187/345 (54%) from previously treated patients. Of 52 MDR isolates randomly selected for extended testing at an international reference laboratory, 27 (51%, 95%CI 38-66) had resistance to pyrazinamide, 21 (40%, 95%CI 27-55) to kanamycin, and 9 (17%, 95%CI 8-30) to ofloxacin.


CONCLUSIONS
The prevalence of MDR-TB in Lithuania is among the world's highest. Among MDR-TB isolates, aminoglycoside and fluoroquinolone resistance were common. To combat drug-resistant TB, Lithuania has implemented the WHO global TB control strategy (DOTS), and is developing an MDR-TB treatment program (DOTS-Plus).
Dewan
P
P
Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. puneet.dewan@sfdph.org
Sosnovskaja
A
A
Thomsen
V
V
Cicenaite
J
J
Laserson
K
K
Johansen
I
I
Davidaviciene
E
E
Wells
C
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D004977:Ethambutol / Q000494:pharmacology; D005260:Female; D006801:Humans; D007538:Isoniazid / Q000494:pharmacology; D008097:Lithuania / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects; D015995:Prevalence; D011897:Random Allocation; D012293:Rifampin / Q000494:pharmacology; D013307:Streptomycin / Q000494:pharmacology; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology*
D004977:Ethambutol; D007538:Isoniazid; D012293:Rifampin; D013307:Streptomycin