Childhood drug-resistant tuberculosis in the Western Cape Province of South Africa.
OBJECTIVE
Continued surveillance of drug resistance amongst children presenting with culture-confirmed tuberculosis to a tertiary care hospital and to community clinics.


METHODS
Drug susceptibility testing for isoniazid and rifampicin was prospectively done on all children presenting with culture-confirmed tuberculosis from three study populations: children diagnosed at Tygerberg Children's Hospital in the Western Cape Province, South Africa, between March 2003 and February 2005 (recent survey, hospital-based group), and August 1994 and April 1998 (previous hospital-based survey), and a community-based group from five clinics during the recent survey.


RESULTS
Isoniazid resistance increased significantly from 6.9% (21/306 children) in the previous survey to 12.8% (40/313 children) in the recent survey (odds ratio (OR) 1.99, 95% confidence interval (CI) 1.11-3.59). Resistance to isoniazid and rifampicin (multidrug resistance) did not increase significantly between the surveys (7/306 in previous survey vs 17/313 in recent survey; OR 2.45, 95% CI 0.94-6.62). All resistance (isoniazid and/or rifampicin) was 18/127 (14.2%) in the community-based group compared to 23/192 (12.0%) in the hospital-based group (OR 0.82, 95% CI 0.41-1.68).


CONCLUSIONS
The prevalence of drug-resistant tuberculosis in this setting is increasing, reflecting ongoing transmission of drug-resistant Mycobacterium tuberculosis.
Schaaf
H Simon
HS
Department of Paediatrics and Child Health, Tygerberg Children's Hospital and Stellenbosh University, Tygerberg, South Africa. hss@sun.ac.za
Marais
Ben J
BJ
Hesseling
Anneke C
AC
Gie
Robert P
RP
Beyers
Nulda
N
Donald
Peter R
PR
D000293:Adolescent; D000995:Antitubercular Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003151:Community Health Centers; D024881:Drug Resistance, Bacterial; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011159:Population Surveillance; D011446:Prospective Studies; D013019:South Africa; D014376:Tuberculosis / Q000188:drug therapy / Q000453:epidemiology*
D000995:Antitubercular Agents