title: Resistance profile and risk factors of drug resistant tuberculosis in the Baltic countries.
abstract: The rates of multi- and extensively drug-resistant tuberculosis (X/MDRTB) in the Baltic countries are the highest within the European Union hampering recent achievements of national TB control programmes. We included all consecutive culture-confirmed X/MDRTB patients registered for treatment in 2009 in Latvia, Lithuania and Estonia into this multicenter case-control study. Cases were compared with randomly selected controls with non-MDRTB registered for treatment in the same year across these sites. Of 495 MDRTB patients, 243 (49.7%) showed resistance to at least one second-line drug, 206 (42.1%) had pre-XDRTB (i.e. MDRTB with additional resistance to a second-line injectable or fluoroquinolones) and 64 (13.1%) had XDRTB. Younger age, male gender and known contact with an MDRTB case were associated with increased risk of primary infection with X/MDRTB strains. Previous treatment and alcohol abuse were strong predictors for MDRTB acquisition; defaults and failures in the past triggered XDRTB development. All patients received appropriate therapy; less than half of the patients were fully adherent. An erroneous treatment strategy is unlikely to drive resistance development. Increasing patients' compliance, addressing issues of social support, rapid detection of drug resistance and improving infection control is crucial for prevention of further spread of X/MDRTB and achieving higher cure rates.
authors.affiliation: Samara Oblast Clinical Tuberculosis Dispensary, 154, Novo-Sadovaya Street, Samara 443068, Russia. Electronic address: ignatyevaolga@rambler.ru.
authors.forename: Olga
authors.initials: O
authors.lastname: Ignatyeva
authors.affiliation: Blizard Institute, Queen Mary University of London, 2 Newark Street, London E1 2AT, UK; Department of Infectious Diseases, Imperial College, Commonwealth Building, Hammersmith Campus, DuCane Road, London W12 ONN, UK; Department for Infectious Disease Epidemiology, Robert Koch Institute, Nordufer 20, D-13353 Berlin-Wedding, Germany. Electronic address: y.balabanova@qmul.ac.uk.
authors.forename: Yanina
authors.initials: Y
authors.lastname: Balabanova
authors.affiliation: Blizard Institute, Queen Mary University of London, 2 Newark Street, London E1 2AT, UK; Department of Infectious Diseases, Imperial College, Commonwealth Building, Hammersmith Campus, DuCane Road, London W12 ONN, UK. Electronic address: v.nikolayevskyy@qmul.ac.uk.
authors.forename: Vladyslav
authors.initials: V
authors.lastname: Nikolayevskyy
authors.affiliation: Samara Oblast Clinical Tuberculosis Dispensary, 154, Novo-Sadovaya Street, Samara 443068, Russia. Electronic address: koshkarek@qip.ru.
authors.forename: Ekaterina
authors.initials: E
authors.lastname: Koshkarova
authors.affiliation: National Tuberculosis and Infectious Diseases University Hospital, P. Širvio g. 5, LT-10214 Vilnius, Lithuania. Electronic address: birute1980@yahoo.com.
authors.forename: Birute
authors.initials: B
authors.lastname: Radiulyte
authors.affiliation: National Tuberculosis and Infectious Diseases University Hospital, P. Širvio g. 5, LT-10214 Vilnius, Lithuania. Electronic address: edita.david@takas.lt.
authors.forename: Edita
authors.initials: E
authors.lastname: Davidaviciene
authors.affiliation: Riga East University Hospital, Centre of TB and Lung Diseases, Linezera iela 3, Rīga LV-1006, Latvia. Electronic address: vija.riekstina@aslimnica.lv.
authors.forename: Vija
authors.initials: V
authors.lastname: Riekstina
authors.affiliation: Tartu University Clinics, Lung Hospital, 1a L. Puusepa St., 50406 Tartu, Estonia. Electronic address: kadri.jaama@kliinikum.ee.
authors.forename: Kadri
authors.initials: K
authors.lastname: Jaama
authors.affiliation: Tartu University Clinics, Lung Hospital, 1a L. Puusepa St., 50406 Tartu, Estonia. Electronic address: manfred.danilovits@kliinikum.ee.
authors.forename: Manfred
authors.initials: M
authors.lastname: Danilovits
authors.affiliation: Marius Nasta Institute of Pneumology, Soseaua Viilor Nr. 90, Sector 5, Bucuresti, RO-050159 Bucharest, Romania. Electronic address: cristoprea@yahoo.com.
authors.forename: Cristina M
authors.initials: CM
authors.lastname: Popa
authors.affiliation: Blizard Institute, Queen Mary University of London, 2 Newark Street, London E1 2AT, UK; Department of Infectious Diseases, Imperial College, Commonwealth Building, Hammersmith Campus, DuCane Road, London W12 ONN, UK. Electronic address: f.drobniewski@imperial.ac.uk.
authors.forename: Francis A
authors.initials: FA
authors.lastname: Drobniewski
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D001454:Baltic States / Q000453:epidemiology; D015897:Comorbidity; D024901:Drug Resistance, Multiple, Bacterial; D054908:Extensively Drug-Resistant Tuberculosis / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000302:isolation & purification / Q000472:pathogenicity; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D017211:Treatment Failure; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology
chemical_list: D000995:Antitubercular Agents
keywords: Baltic countries; Clinical management; Multi/extensive drug resistant tuberculosis; Risk factors