title: Epidemiology of MDR-TB in a Belgian infectious diseases unit: a 15 years review.
abstract: BACKGROUND
  For the last 20 years the world has seen the emergence of a growing epidemic of MDR-TB, followed by the appearance of XDR-TB. Both require longer, more expensive and more toxic treatments. MDR-TB and especially XDR-TB are associated with a lower cure rate than non MDR-TB.
  
  
  METHODS
  We reviewed retrospectively all cases of MDR-and XDR-TB managed at St Pierre University Hospital between 1996 and 2010. Epidemiological, clinical, bacteriological, treatment, follow up and outcome were collected and analysed.
  
  
  RESULTS
  We recorded 73 instances of MDR-TB and 11 XDR-TB for a total of 78 patients. All but 4 patients were of non Belgian origin. 10 patients were co-infected with HIV. A median of 4 active drugs (1-5) were used for a median of 448 days (329-616). 41 MDR-TB (56%) and 1 XDR-TB (1%) were considered as cured and 20 are still on treatment. Since 2007, increasing resistance to second line injectable drugs, fluoroquinolones and even linezolid (1 case) is observed. Extensive resistance was mainly found in patients who had previously been mismanaged with second line agents.
  
  
  CONCLUSIONS
  This study illustrates the growing epidemic of MDR and XDR-TB, it emphasizes the importance of proper diagnosis and adequate management of TB in patients at risk for resistance and stresses the need for new therapies.
authors.affiliation: CHU Saint-Pierre Infectious Diseases Department, Brussels, Belgium. maladiesinfectieuses@stpierre-bru.be
authors.forename: R
authors.initials: R
authors.lastname: van Heurck
authors.affiliation: CHU Saint-Pierre Infectious Diseases Department, Brussels, Belgium.
authors.forename: M C
authors.initials: MC
authors.lastname: Payen
authors.affiliation: CHU Saint-Pierre Infectious Diseases Department, Brussels, Belgium.
authors.forename: S
authors.initials: S
authors.lastname: De Wit
authors.affiliation: CHU Saint-Pierre Infectious Diseases Department, Brussels, Belgium.
authors.forename: N
authors.initials: N
authors.lastname: Clumeck
mesh_terms: D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use; D001530:Belgium / Q000453:epidemiology; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000453:epidemiology*
chemical_list: D000995:Antitubercular Agents