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Survey of Drug Resistance of Mycobacterium tuberculosis in 3 Mexican States, 1997
Reuben M. Granich, MD, MPH;
Susana Balandrano, Biol;
Adalberto J. Santaella, MD, MPH;
Nancy J. Binkin, MD, MPH;
Kenneth G. Castro, MD;
Alma Marquez-Fiol, MD;
Georgina Anzaldo, QFB;
Margarita Zarate, MD;
Maria Luisa Jaimes, MD;
Oscar Velazquez-Monroy, MD;
Lourdes Salazar, Enf;
Carlos Alvarez-Lucas, DDM;
Pablo Kuri, MD, MSc;
Ana Flisser, BiolDrSc;
Jose Santos-Preciado, MD, MSc;
Cuauhtemoc Ruiz-Matus, MD, MPH;
Roberto Tapia-Conyer, MD, MPH;
Jordan W. Tappero, MD, MPH
Arch Intern Med. 2000;160:639-644.
Background Drug resistance threatens global tuberculosis (TB) control efforts. Population-based estimates of drug resistance are needed to develop strategies for controlling drug-resistant TB in Mexico.
Objective To obtain population-based data on Mycobacterium tuberculosis drug resistance in Mexico.
Methods To obtain drug resistance data, we conducted a population-based study of TB cases in the states of Baja California, Sinaloa, and Oaxaca, Mexico. We performed cultures and drug susceptibility testing on M tuberculosis isolates from patients with newly diagnosed, smear-positive TB from April 1 to October 31, 1997.
Results Mycobacterium tuberculosis was isolated from 460 (75%) of the 614 patients. Levels of resistance in new and retreatment TB cases to 1 or more of the 3 current first-line drugs used in Mexico (isoniazid, rifampin, and pyrazinamide) were 12.9% and 50.5%, respectively; the corresponding levels of multi–drug-resistant TB were 2.4% and 22.4%. Retreatment cases were significantly more likely than new cases to have isolates resistant to 1 or more of the 3 first-line drugs (relative risk [RR], 3.9; 95% confidence interval [CI], 2.8-5.5), to have isoniazid resistance (RR, 3.6; 95% CI, 2.5-5.2), and to have multi–drug-resistant TB (RR, 9.4; 95% CI, 4.3-20.2).
Conclusions This population-based study of M tuberculosis demonstrates moderately high levels of drug resistance. Important issues to consider in the national strategy to prevent M tuberculosis resistance in Mexico include consideration of the most appropriate initial therapy in patients with TB, the treatment of patients with multiple drug resistance, and surveillance or periodic surveys of resistance among new TB patients to monitor drug resistance trends.
From the Division of Tuberculosis Elimination, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Ga (Drs Granich, Binkin, Castro, and Tappero); Instituto Nacional de Diagnóstico y Referencia Epidemiológicos (Ms Balandrano and Dr Flisser); Dirección General de Epidemiología (Drs Santaella, Marquez-Fiol, Anzaldo, Zarate, Alvarez-Lucas, and Kuri), Coordinación de Vigilancia Epidemiológica (Drs Jaimes, Velazquez-Monroy, and Santos-Preciado and Ms Salazar); and Subsecretaria de Prevención y Control de Enfermedades (Drs Ruiz-Matus and Tapia-Conyer).
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