title: Prevalence of anti-tuberculosis drug resistance in foreign-born tuberculosis cases in the U.S. and in their countries of origin.
abstract: BACKGROUND
  Foreign-born individuals comprise >50% of tuberculosis (TB) cases in the U.S. Since anti-TB drug resistance is more common in most other countries, when evaluating a foreign-born individual for TB, one must consider the risk of drug resistance. Naturally, clinicians query The Global Project on Anti-tuberculosis Drug Resistance Surveillance (Global DRS) which provides population-based data on the prevalence of anti-TB drug resistance in 127 countries starting in 1994. However, foreign-born persons in the U.S. are a biased sample of the population of their countries of origin, and Global DRS data may not accurately predict their risk of drug resistance. Since implementing drug resistance surveillance in 1993, the U.S. National TB Surveillance System (NTSS) has accumulated systematic data on over 130,000 foreign-born TB cases from more than 200 countries and territories. Our objective was to determine whether the prevalence of drug resistance among foreign-born TB cases correlates better with data from the Global DRS or with data on foreign-born TB cases in the NTSS.
  
  
  RESULTS
  We compared the prevalence of resistance to isoniazid and rifampin among foreign-born TB cases in the U.S., 2007-2009, with US NTSS data from 1993 to 2006 and with Global DRS data from 1994-2007 visually with scatterplots and statistically with correlation and linear regression analyses. Among foreign-born TB cases in the U.S., 2007-2009, the prevalence of isoniazid resistance and multidrug resistance (MDR, i.e. resistance to isoniazid and rifampin), correlated much better with 1993-2006 US surveillance data (isoniazid: r = 0.95, P<.001, MDR: r = 0.75, P<.001) than with Global DRS data, 1994-2007 (isoniazid: r = 0.55, P = .001; MDR: r = 0.50, P<.001).
  
  
  CONCLUSIONS
  Since 1993, the US NTSS has accumulated sufficient data on foreign-born TB cases to estimate the risk of drug resistance among such individuals better than data from the Global DRS.
authors.affiliation: Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, the US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Allison B
authors.initials: AB
authors.lastname: Taylor
authors.forename: Ekaterina V
authors.initials: EV
authors.lastname: Kurbatova
authors.forename: J Peter
authors.initials: JP
authors.lastname: Cegielski
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use*; D002487:Centers for Disease Control and Prevention, U.S.; D024881:Drug Resistance, Bacterial; D054242:Emigrants and Immigrants; D062665:Epidemiological Monitoring; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use*; D008826:Microbial Sensitivity Tests; D009169:Mycobacterium tuberculosis / Q000187:drug effects; D015995:Prevalence; D012293:Rifampin / Q000627:therapeutic use*; D014376:Tuberculosis / Q000188:drug therapy* / Q000453:epidemiology; D014481:United States
chemical_list: D000995:Antitubercular Agents; D007538:Isoniazid; D012293:Rifampin