Increasing incidence of extrapulmonary tuberculosis but stable rates of resistance of Mycobacterium tuberculosis isolates to first-line anti-tubercular drugs in Kuwait, 19962005
Abstract number: P1565
Mokaddas E., Ahmad S., Samir I.
Objective: Continuous nationwide monitoring of drug-resistance levels is important for proper control/management of tuberculosis (TB). The aim of this study was to determine the incidence of pulmonary and extrapulmonary TB and trends in drug resistance patterns among all Mycobacterium tuberculosis strains isolated over a ten-year period in Kuwait.
Methods: Drug susceptibility data for M. tuberculosis isolates recovered from all pulmonary and extrapulmonary TB patients in Kuwait from January 1996 to December 2005 were collected and analysed. Patients were divided into Kuwaiti nationals and expatriates. Prior treatment status was not recorded.
Results: From 1996 to 2005, 5399 nonrepetitive culture-positive TB cases (56% from pulmonary sites and 44% from extrapulmonary sites) among 917 (17%) Kuwaiti nationals and 4482 (83%) expatriates were identified. Although the total number of TB cases remained nearly same, downward and upward trends in the rate of M. tuberculosis isolates recovered from pulmonary and extrapulmonary specimens, respectively, were observed. Overall resistance rates were as follows: any drug, 12.5%; isoniazid, 9.1%; rifampicin, 1.1%; ethambutol, 2.0%; streptomycin, 4.3% and multidrug resistance (MDR), 0.9%. The resistance rates over the study period remained nearly same. However, significantly higher resistance rates for rifampicin and MDR among pulmonary versus extrapulmonary cases and for any drug, isoniazid and ethambutol among isolates recovered from expatriate versus Kuwaiti patients were observed.
Conclusions: The total number of active TB cases from 1996 to 2005 remained nearly same in Kuwait. Moderate and stable single drug resistance (<10%) and low MDR rates (<1%) were found among M. tuberculosis strains. The increasing incidence of extrapulmonary TB cases suggests that majority of active TB cases in Kuwait are occurring due to reactivation of previously acquired infection. The findings also highlight the importance of ongoing control measures to limit the development and spreading of drug-resistant M. tuberculosis strains in Kuwait.
Supported in part by KURA grant MI 02/04.
|Session name:||18th European Congress of Clinical Microbiology and Infectious Diseases|
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