title: Multidrug and extensively drug-resistant tuberculosis in Canada 1997-2008: demographic and disease characteristics.
abstract: METHODS
  Nationwide Canadian public health surveillance.
  
  
  OBJECTIVE
  Description of demographic features and disease characteristics of drug-resistant tuberculosis (TB) in Canada over a 12 year period.
  
  
  METHODS
  Continuous surveillance of all cases of culture-confirmed TB in Canada. Demographic and microbiologic features were analyzed and comparisons between drug-susceptible, multidrug-resistant (MDR), and drug-resistant not-MDR were made. Cases of extensively drug resistant TB are described.
  
  
  RESULTS
  15,993 cases of culture-confirmed TB were reported during the study period. There were 5 cases of XDR-TB, 177 cases of MDR-TB, and 1,234 cases of first-line drug resistance not-MDR. The majority of drug-resistant cases were reported in foreign-born individuals, with drug-resistant cases diagnosed earlier post-arrival in Canada compared to drug-susceptible cases. In MDR-TB isolates, there was a high rate of drug-resistance to other first- and second-line drugs, making reliable empiric therapeutic recommendations for MDR-TB difficult. There was a statistically significant association between both MDR and drug-resistance not-MDR, and the risk of a negative treatment outcome (defined as treatment failure, absconded, or treatment ongoing >3 yrs).
  
  
  CONCLUSIONS
  Drug-resistance complicates TB management even in developed nations with well-established TB control programs. The predominantly international origin of drug-resistant cases highlights the need for global strategies to combat TB.
authors: Department of Medical Microbiology & Immunology, University of Alberta, Edmonton, Canada.
authors: Jessica
authors: J
authors: Minion
authors: Victor
authors: V
authors: Gallant
authors: Joyce
authors: J
authors: Wolfe
authors: Frances
authors: F
authors: Jamieson
authors: Richard
authors: R
authors: Long
mesh_terms: D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002170:Canada / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003710:Demography; D054908:Extensively Drug-Resistant Tuberculosis / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000302:isolation & purification; D013997:Time Factors; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D014944:World Health Organization; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents