title: Resistance to first-line antituberculosis drugs in Spain, 2010-2011. RETUBES Study.
abstract: BACKGROUND
  The magnitude of current resistance to antituberculosis drugs in Spain is unknown. The objective of this study is to describe resistance to first-line antituberculosis drugs and determine the associated factors.
  
  
  METHODS
  Prospective multicenter study of adult tuberculosis patients with positive Mycobacterium tuberculosis culture and antibiogram including first-line drugs in 32 hospitals and one out-patient center of the Spanish Health System between 2010 and 2011.
  
  
  RESULTS
  A total of 519 patients, 342 Spanish nationals and 177 (34.1%) foreigners were studied. Drug resistance was found in 48 (9.2%), of which 35 (6.7%) were isoniazid-resistant. There were 10 (1.9%) multiresistant cases and no strain was extremely resistant. Initial isoniazid resistance was detected in 28 of the 487 (5.7%) antituberulosis-naïve patients, most of whom were foreigners (P<.01). Acquired resistance was seen in 7 (22.6%) previously treated cases. Multiresistance was initial in 6 cases (1.2%) and acquired in another 4 (12.9%). Factors associated with initial isoniazid resistance were immigrant status and group cohabitation OR=2.3; 95%CI: .98-5.67 and OR=2.2; 95%CI: 1.05-7.07 respectively). The factor associated with acquired resistance to isoniazid was age below 50 years (P=.03).
  
  
  CONCLUSIONS
  The rate of initial isoniazid resistance is greater than estimated, probably due to the increase in immigration during recent years, suggesting that systematic national monitoring is required. Immigrants and those who cohabit in groups have a higher risk of isoniazid resistance.
authors.affiliation: Servicio de Neumología, Hospital Universitario Dr. Peset, Valencia, España; Programa Integrado de Investigación en Tuberculosis de SEPAR (PII-TB). Electronic address: rafa267.rb@gmail.com.
authors.forename: Rafael
authors.initials: R
authors.lastname: Blanquer
authors.affiliation: Fundación Respira de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, España; Programa Integrado de Investigación en Tuberculosis de SEPAR (PII-TB); Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP).
authors.forename: Teresa
authors.initials: T
authors.lastname: Rodrigo
authors.affiliation: Agencia de Salud Pública de Barcelona, Barcelona, España; Programa Integrado de Investigación en Tuberculosis de SEPAR (PII-TB); Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP).
authors.forename: Martí
authors.initials: M
authors.lastname: Casals
authors.affiliation: Servicio de Neumología, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, España; Programa Integrado de Investigación en Tuberculosis de SEPAR (PII-TB); Centro de Investigación Biomédica en Red de Respiratorio (CIBERESP).
authors.forename: Juan
authors.initials: J
authors.lastname: Ruiz Manzano
authors.affiliation: Servicio de Neumología, Hospital San Agustín, Avilés, Asturias, España; Programa Integrado de Investigación en Tuberculosis de SEPAR (PII-TB).
authors.forename: José María
authors.initials: JM
authors.lastname: García-García
authors.affiliation: Servicio de Neumología, Hospital La Marina Baixa, Villajoyosa, Alicante, España; Programa Integrado de Investigación en Tuberculosis de SEPAR (PII-TB).
authors.forename: José Luís
authors.initials: JL
authors.lastname: Calpe
authors.affiliation: Servicio de Enfermedades Infecciosas, Hospital Carlos III, Madrid, España; Programa Integrado de Investigación en Tuberculosis de SEPAR (PII-TB).
authors.forename: Eulalia
authors.initials: E
authors.lastname: Valencia
authors.affiliation: Servicio de Neumología, Hospital de Cabueñes, Gijón, Asturias, España; Programa Integrado de Investigación en Tuberculosis de SEPAR (PII-TB).
authors.forename: Teresa
authors.initials: T
authors.lastname: Pascual
authors.affiliation: Servicio de Neumología, Hospital son Llàtzer, Palma de Mallorca, Islas Baleares, España; Programa Integrado de Investigación en Tuberculosis de SEPAR (PII-TB).
authors.forename: Isabel
authors.initials: I
authors.lastname: Mir
authors.affiliation: Unidad de Prevención y Control de la Tuberculosis, Barcelona, España; Programa Integrado de Investigación en Tuberculosis de SEPAR (PII-TB).
authors.forename: María Ángeles
authors.initials: MÁ
authors.lastname: Jiménez
authors.affiliation: Hospital Insular de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, España; Programa Integrado de Investigación en Tuberculosis de SEPAR (PII-TB).
authors.forename: Fernando
authors.initials: F
authors.lastname: Cañas
authors.affiliation: Servicio de Neumología, Hospital de Vall d'Hebron, Barcelona, España; Programa Integrado de Investigación en Tuberculosis de SEPAR (PII-TB).
authors.forename: Rafael
authors.initials: R
authors.lastname: Vidal
authors.affiliation: Servicio de Neumología, Complejo Hospitalario Xeral-Calde, Lugo, España; Programa Integrado de Investigación en Tuberculosis de SEPAR (PII-TB).
authors.forename: Antón
authors.initials: A
authors.lastname: Penas
authors.affiliation: Agencia de Salud Pública de Barcelona, Barcelona, España; Programa Integrado de Investigación en Tuberculosis de SEPAR (PII-TB); Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP).
authors.forename: Joan A
authors.initials: JA
authors.lastname: Caylà
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology; D000995:Antitubercular Agents / Q000494:pharmacology* / Q000627:therapeutic use; D015897:Comorbidity; D003441:Crowding; D024901:Drug Resistance, Multiple, Bacterial; D004359:Drug Therapy, Combination; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000302:isolation & purification; D015995:Prevalence; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors; D013030:Spain / Q000453:epidemiology; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology*
chemical_list: D000995:Antitubercular Agents
keywords: Drug resistance; Factores de riesgo; Isoniacida; Isoniazid; Multiresistant tuberculosis; Resistencia a fármacos; Risk factors; Tuberculosis; Tuberculosis multirresistente