Surveillance of Mycobacterium tuberculosis drug resistance France, 1995-1997

OBJECTIVE: To measure the rate of primary and secondary drug resistance of Mycobacterium tuberculosis on an ongoing basis. DESIGN: Data on all culture-positive tuberculosis were collected prospectiv ely from 1995 through 1997 from a microbiological laboratory network of 19 university hospitals throughout France, and submitted quarterly to the Nati onal Reference Centre for Surveillance of Mycobacterial Diseases. RESULTS: A total of 2998 patients were included in the study. Among the 233 3 (78%) previously untreated patients, 8.6% had isolates resistant to any d rug, 4.8% to streptomycin (SM) alone, 1.2% to isoniazid (INH) alone, 1.8% t o SM + INH, and 0.3% to INH + rifampicin (RMP) or multidrug resistance (MDR ). Foreign birth was independently associated with a higher risk of primary resistance to any drug (odds ratio [OR] 1.5). Among the 268 (9%) previousl y treated patients, 20.9% had isolates resistant to any drug, 6.3% to SM al one, 3.4% to INH alone, 4.1% to SM + INH, and 3.7% to INH + RMP. Foreign bi rth (OR = 2.3), and human immunodeficiency virus positive status (OR = 4.4) were independently associated with a higher risk of secondary resistance t o any drug. CONCLUSION: During the last 30 years there has been no increase in resistan ce to any drug among previously untreated patients. As expected, secondary resistance was highly associated with foreign birth. MDR-TB remains a rare event in France.