title: Long-term molecular surveillance of multidrug-resistant tuberculosis in Spain.
abstract: The data presented here span 11 years (1998-2008) of monitoring of multidrug-resistant tuberculosis (MDR-TB) clustering through molecular typing techniques in Spain. The molecular and epidemiological data of 480 multidrug-resistant Mycobacterium tuberculosis complex isolates were analyzed. Thirty-one clusters involving 157 (32.7%) patients were identified. The proportion of immigrants increased substantially over the study period reaching 65% in 2008; however, the clustering rate remained stable indicating that local transmission was little influenced by imported MDR-TB. The three major clusters respond to the persistence of two autochthonous strains throughout the study period and an extensively drug-resistant (XDR) Mycobacterium bovis outbreak with only two cases was reported since 2002. Molecular and epidemiological evidence for the importation of new strains and their spread within the community was found. Immigrant-only clusters most often grouped patients infected abroad with strains belonging to rare spoligotypes. Conversely, widespread spoligotypes of the Latin-American and Mediterranean (LAM) and Haarlem families were responsible for the majority of the MDR-TB local transmission. The demonstration of clusters spanning several Spanish regions that have been ongoing throughout the study period makes it advisable to maintain a continuous molecular surveillance in order to monitor the spread of MDR-TB.
authors.affiliation: IIS Aragón, Hospital Universitario Miguel Servet, Padre Arrupe s/n, 50009 Zaragoza, Spain. pgavinb.iacs@aragon.es
authors.forename: Patricia
authors.initials: P
authors.lastname: Gavín
authors.forename: María José
authors.initials: MJ
authors.lastname: Iglesias
authors.forename: María Soledad
authors.initials: MS
authors.lastname: Jiménez
authors.forename: Elena
authors.initials: E
authors.lastname: Rodríguez-Valín
authors.forename: Daniel
authors.initials: D
authors.lastname: Ibarz
authors.forename: María Antonia
authors.initials: MA
authors.lastname: Lezcano
authors.forename: María José
authors.initials: MJ
authors.lastname: Revillo
authors.forename: Carlos
authors.initials: C
authors.lastname: Martín
authors.forename: Sofía
authors.initials: S
authors.lastname: Samper
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015373:Bacterial Typing Techniques; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D004269:DNA, Bacterial; D054242:Emigrants and Immigrants; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D018598:Minisatellite Repeats; D058885:Multilocus Sequence Typing; D009169:Mycobacterium tuberculosis / Q000145:classification / Q000235:genetics* / Q000302:isolation & purification; D013030:Spain / Q000453:epidemiology; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D004269:DNA, Bacterial