EPIDEMIOLOGY OF MULTIDRUG-RESISTANT TUBER CULOSIS IN FRANCE (1992-1993)

Multi-drug resistance of the tubercle bacillus, defined as resistance to at least isoniazid and rifampin, greatly compromises the chances of cure. Secondary multi-drug resistance develops when therapeutic probl ems (prescription errors, non compliance) lead to successive selection of resistant mutant bacilli. If patients harbouring multi-drug resist ant bacilli infect contact persons who further develop tuberculosis di sease, resistance in those persons will be primary. In the past few ye ars, an increase in prevalence of multi-drug resistance has been repor ted in several regions of the world (particularly in New York City), a nd several epidemics of multi-drug resistant tuberculosis mainly conce rning HIV-infected subjects have been reported (USA, France). A nation al surveillance has been carried out in France since 1992 among all ho spital microbiology laboratories. Prevalence of multi-drug resistance is low (0.5 % of all cases of culture-proven tuberculosis) and much lo wer than that estimated in the USA. Most cases are patients who have p robably acquired multi-drug resistance during treatment, either abroad for some patients of foreign origin, or in France for other patients. This implies that rigourous therapeutic follow-up of all patients is a priority. For some cases (8 in 1992) primary resistance is suspected , and a large proportion of these cases (43 %) concerns HIV-infected p ersons. These cases should be systematically investigated in order to find the source of infection. Measures to prevent nosocomial transmiss ion of multi-drug resistant bacilli are essential.