title: Characteristics of drug-resistant tuberculosis in Abkhazia (Georgia), a high-prevalence area in Eastern Europe.
abstract: Although multidrug-resistant (MDR) tuberculosis (TB) is a major public health problem in Eastern Europe, the factors contributing to emergence, spread and containment of MDR-TB are not well defined. Here, we analysed the characteristics of drug-resistant TB in a cross-sectional study in Abkhazia (Georgia) between 2003 and 2005, where standard short-course chemotherapy is supplemented with individualized drug-resistance therapy. Drug susceptibility testing (DST) and molecular typing were carried out for Mycobacterium tuberculosis complex strains from consecutive smear-positive TB patients. Out of 366 patients, 60.4% were resistant to any first-line drugs and 21% had MDR-TB. Overall, 25% of all strains belong to the Beijing genotype, which was found to be strongly associated with the risk of MDR-TB (OR 25.9, 95% CI 10.2-66.0) and transmission (OR 2.8, 95% CI 1.6-5.0). One dominant MDR Beijing clone represents 23% of all MDR-TB cases. The level of MDR-TB did not decline during the study period, coinciding with increasing levels of MDR Beijing strains among previously treated cases. Standard chemotherapy plus individualized drug-resistance therapy, guided by conventional DST, might be not sufficient to control MDR-TB in Eastern Europe in light of the spread of "highly transmissible" MDR Beijing strains circulating in the community.
authors.affiliation: Dipartimento di Malattie Infettive, Parassitarie e Immunomediate, Istituto Superiore di Sanità, Rome, Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: Pardini
authors.forename: Stefan
authors.initials: S
authors.lastname: Niemann
authors.forename: Francis
authors.initials: F
authors.lastname: Varaine
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Iona
authors.forename: Francesca
authors.initials: F
authors.lastname: Meacci
authors.forename: Germano
authors.initials: G
authors.lastname: Orrù
authors.forename: Hasan
authors.initials: H
authors.lastname: Yesilkaya
authors.forename: Thierry
authors.initials: T
authors.lastname: Jarosz
authors.forename: Peter
authors.initials: P
authors.lastname: Andrew
authors.forename: Mike
authors.initials: M
authors.lastname: Barer
authors.forename: Francesco
authors.initials: F
authors.lastname: Checchi
authors.forename: Heinz
authors.initials: H
authors.lastname: Rinder
authors.forename: Graziella
authors.initials: G
authors.lastname: Orefici
authors.forename: Sabine
authors.initials: S
authors.lastname: Rüsch-Gerdes
authors.forename: Lanfranco
authors.initials: L
authors.lastname: Fattorini
authors.forename: Marco Rinaldo
authors.initials: MR
authors.lastname: Oggioni
authors.forename: Maryline
authors.initials: M
authors.lastname: Bonnet
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D016172:DNA Fingerprinting / Q000379:methods; D005260:Female; D005838:Genotype; D005846:Georgia (Republic) / Q000453:epidemiology; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D058889:Molecular Typing; D009169:Mycobacterium tuberculosis / Q000145:classification / Q000187:drug effects* / Q000235:genetics; D012307:Risk Factors; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents