DRUG-RESISTANT PULMONARY TUBERCULOSIS IN BERLIN, GERMANY, 1987-1993

Resistance of Mycobacterium tuberculosis (M.tb) strains is an increasi ng problem worldwide. Since no public health data are available for ur ban populations in Germany, we investigated resistance in our hospital ized patients (n=1,011) over the last 7 yrs. We therefore evaluated cl inical data and results of susceptibility tests (breakpoint technique/ proportion method) for isoniazid, streptomycin, rifampin, pyrazinamide , protionamide and ethambutol. Since 1987, there has been a relatively constant rate of 5.9% (3.9%-7.8%) for single-drug resistance (SDR), b ut an increasing rate of multidrug-resistant (MDR) strains (greater th an or equal to 2 first-line drugs) from 1.7% in 1987 to 5.8% in 1993. Sixty nine percent of patients with MDR strains showed resistance to t wo drugs, and 31% to three or more drugs. Risk factors for SDR and MDR tuberculosis revealed previous therapy (odds ratio (OR) (95% confiden ce interval (95% CI)); SDR 2.2 (1.7-4.0); MDR 4.5 (2.3-8.8)); and fore ign-born status (SDR 2.2 (1.3-3.6); MDR 3.5 (1.8-6.8)) to be the most important factors associated with resistance. Both primary and acquire d resistance were higher in foreign-born than in German-born patients. We conclude that there was a considerable increase in multidrug-resis tant tuberculosis in our hospital from 1987 to 1993. Since previously treated patients and patients born in countries with a high level of p rimary resistance had an increased risk of drug-resistant tuberculosis , we would advise a four drug regimen as initial therapy in those pati ents.