title: [Impact of immigration on drug resistance to Mycobacterium tuberculosis in Castellon (Spain): 1995-2003].
abstract: OBJECTIVE
  The aim of this study was to know the frequency of resistant Mycobacterium tuberculosis in the province of Castellon (Spain) and to determine whether immigration is associated with resistance.
  
  
  METHODS
  All culture-positive cases diagnosed in Castellon from January 1995 to December 2003 were included in this retrospective study. Susceptibility tests were performed using the Canetti's proportion method and the MB/BacT system. Risk factors associated with tuberculosis were investigated in every case.
  
  
  RESULTS
  Six hundred and forty-four cases of tuberculosis were studied: 560 were Spaniards and 84 foreigners. The overall frequency of resistant strains was 5%. The total rate of resistance in Spaniards was 3.7% and in foreigners 13.1%. In Spanish new cases, drug resistance was 3.2% and in foreigners new cases it was 13.9%. In previously treated cases, drug resistance was 6.7% in Spaniards and 0% in immigrants. No acquired drug resistance was detected in immigrants. Of those strains with resistance, 71.9% had resistance to only one drug, 18.7% to two drugs and 9.4% to more than two drugs. Multidrug-resistance was found in 9.4% of the resistant cases, and in 0.5% of all the studied population. The presence of resistant Mycobacterium tuberculosis was associated with the fact of having a foreign nationality (OR = 3.87; p < 0.001).
  
  
  CONCLUSIONS
  Tuberculosis has been diminishing in Spanish patients in Castellon. Nevertheless, there is an important increase in the number of cases in foreigners, which is associated with a major percentage of resistances. Epidemiological vigilance efforts should especially concentrate on this group in order to support the progressive declivity of the disease.
authors.affiliation: Sección de Microbiología, Hospital General, Castellón, España.
authors.forename: María Dolores
authors.initials: MD
authors.lastname: Tirado Balaguer
authors.forename: Rosario
authors.initials: R
authors.lastname: Moreno Muñoz
authors.forename: Margarita
authors.initials: M
authors.lastname: Marín Royo
authors.forename: Francisco
authors.initials: F
authors.lastname: González Morán
authors.forename: Francisco
authors.initials: F
authors.lastname: Pardo Serrano
authors.forename: Alfonso
authors.initials: A
authors.lastname: García del Busto Remón
authors.forename: Pablo
authors.initials: P
authors.lastname: Prada Alfaro
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D024881:Drug Resistance, Bacterial; D004641:Emigration and Immigration; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects*; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D014376:Tuberculosis / Q000453:epidemiology* / Q000382:microbiology