title: Epidemiology of antituberculosis drug resistance in Saudi Arabia: findings of the first national survey.
abstract: The real magnitude of antituberculosis (anti-TB) drug resistance in Saudi Arabia is still unknown because the available data are based on retrospective laboratory studies that were limited to hospitals or cities. A representative national survey was therefore conducted to investigate the levels and patterns of anti-TB drug resistance and explore risk factors. Between August 2009 and July 2010, all culture-positive TB patients diagnosed in any of the tuberculosis reference laboratories of the country were enrolled. Isolates obtained from each patient were tested for susceptibility to first-line anti-TB drugs by the automated Bactec MGIT 960 method. Of the 2,235 patients enrolled, 75 cases (3.4%) were lost due to culture contamination and 256 (11.5%) yielded nontuberculous mycobacteria (NTM). Finally, 1,904 patients (85.2% of those enrolled) had available drug susceptibility testing results. Monoresistance to streptomycin (8.1%; 95% confidence interval [CI], 7.2 to 9.1), isoniazid (5.4%; 95% CI, 4.7 to 6.2), rifampin (1%; 95% CI, 0.7 to 1.3) and ethambutol (0.8%; 95% CI, 0.5 to 1.2) were observed. Multidrug-resistant TB (MDR-TB) was found in 1.8% (95% CI, 1.4 to 2.4) and 15.9% (95% CI, 15.4 to 16.5) of new and previously treated TB cases, respectively. A treatment history of active TB, being foreign-born, having pulmonary TB, and living in the Western part of the country were the strongest independent predictors of MDR-TB. Results from the first representative national anti-TB drug resistance survey in Saudi Arabia suggest that the proportion of MDR-TB is relatively low, though there is a higher primary drug resistance. A strengthened continuous surveillance system to monitor trends over time and second-line anti-TB drug resistance as well as implementation of innovative control measures, particularly among immigrants, is warranted.
authors: Mycobacteriology Research Section, Department of Infection and Immunity, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. hajoj@kfshrc.edu.sa
authors: Sahal
authors: S
authors: Al-Hajoj
authors: Bright
authors: B
authors: Varghese
authors: Mohammed M
authors: MM
authors: Shoukri
authors: Ruba
authors: R
authors: Al-Omari
authors: Mais
authors: M
authors: Al-Herbwai
authors: Fahad
authors: F
authors: Alrabiah
authors: Abdulrahman A
authors: AA
authors: Alrajhi
authors: Naila
authors: N
authors: Abuljadayel
authors: Sahar
authors: S
authors: Al-Thawadi
authors: Alimuddin
authors: A
authors: Zumla
authors: Matteo
authors: M
authors: Zignol
authors: Mario C
authors: MC
authors: Raviglione
authors: Ziad
authors: Z
authors: Memish
mesh_terms: D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000494:pharmacology / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial / Q000187:drug effects; D062665:Epidemiological Monitoring; D004977:Ethambutol / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D007538:Isoniazid / Q000494:pharmacology / Q000627:therapeutic use; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000502:physiology; D012293:Rifampin / Q000494:pharmacology / Q000627:therapeutic use; D012307:Risk Factors; D012529:Saudi Arabia / Q000453:epidemiology; D013307:Streptomycin / Q000494:pharmacology / Q000627:therapeutic use; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology
chemical_list: D000995:Antitubercular Agents; D004977:Ethambutol; D007538:Isoniazid; D012293:Rifampin; D013307:Streptomycin