title: Drug-resistant tuberculosis in Israel: risk factors and treatment outcomes.
abstract: METHODS
  All culture-positive tuberculosis (TB) isolates in Israel.
  
  
  OBJECTIVE
  To outline the magnitude of drug-resistant TB in Israel, describe treatment outcomes and identify risk factors.
  
  
  METHODS
  Retrospective study of laboratory data of all strains of adult TB patients tested for resistance to first- and second-line anti-tuberculosis drugs between 1999 and 2010.
  
  
  RESULTS
  Of 4652 reported TB cases, 3552 (76.3%) underwent culture (annual range 73-81%); 445 (12.5%) were resistant to one or more first-line drugs, while 207 (5.8%) had multidrug-resistant TB (MDR-TB). Risk factors for MDR-TB included being male, age 30-59 years, migrants (mainly from the former Soviet Union [FSU]) who had stayed in Israel >2 years, and having pulmonary TB, human immunodeficiency virus (HIV) infection and sputum smear positivity. Of all MDR-TB patients, 71.0% achieved treatment success, while 19.8% died. Twelve Israeli citizens had extensively drug-resistant TB (5.8% of MDR-TB cases). All had emigrated from the FSU and had pulmonary TB; 1 was HIV-infected. Seven (58.4%) achieved treatment success and 5 (41.6%) died.
  
  
  CONCLUSIONS
  Drug-resistant TB in Israel is influenced by migration, especially from the FSU, where the patients were probably infected. Rapid sputum sampling performed in the early stages of the disease, patient isolation and drug susceptibility testing should be the standard of care to avoid further transmission and improve TB control.
authors.affiliation: Department of Tuberculosis and AIDS, Ministry of Health, Jerusalem, Israel.
authors.forename: Z
authors.initials: Z
authors.lastname: Mor
authors.affiliation: National Tuberculosis Laboratory, National Public Health Laboratory, Ministry of Health, Tel Aviv, Israel.
authors.forename: D
authors.initials: D
authors.lastname: Goldblatt
authors.affiliation: National Tuberculosis Laboratory, National Public Health Laboratory, Ministry of Health, Tel Aviv, Israel.
authors.forename: H
authors.initials: H
authors.lastname: Kaidar-Shwartz
authors.affiliation: Department of Tuberculosis and AIDS, Ministry of Health, Jerusalem, Israel.
authors.forename: N
authors.initials: N
authors.lastname: Cedar
authors.affiliation: National Public Health Laboratory, Ministry of Health, Tel Aviv, Israel.
authors.forename: E
authors.initials: E
authors.lastname: Rorman
authors.affiliation: Department of Tuberculosis and AIDS, Ministry of Health, Jerusalem, Israel.
authors.forename: D
authors.initials: D
authors.lastname: Chemtob
mesh_terms: D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D054908:Extensively Drug-Resistant Tuberculosis / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D007223:Infant; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009169:Mycobacterium tuberculosis; D012189:Retrospective Studies; D012307:Risk Factors; D013183:Sputum / Q000382:microbiology; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000453:epidemiology*; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents