Background: Drug-resistant tuberculosis (TB) represents a threat in TB control, because of cumbersome clinical management, toxicity and prolonged treatment. Drug resistance trend in Emilia-Romagna, a region of Northern Italy, is not increasing and in 2016 is even decreased. The present study describes the TB epidemiological and anti-TB drug resistance trend among natives and foreign-born cases between 2009 and 2017, in a low TB burden and high immigrant receiving setting (Ferrara, a city of Northern Italy, Emilia-Romagna region). Methods: We retrospectively identified all bacteriologically confirmed TB cases (confirmed by NAAT or culture) diagnosed in Ferrara University-Hospital from 2009 to 2017. We recorded gender, age, country of birth, site of disease, smear positivity, sensitivity or resistance toward one (mono-resistant), two or more first-line anti-TB drug (poly-resistant), MDR, and XDR-TB. Results: 109 out of the 167 TB cases (65.3%) were foreign-born and 58 natives, 95 males and 72 females, 120 pulmonary (PTB) and 47 extra-pulmonary (EPTB) cases. Among PTB cases, a positive smear was recorded in 56.6 % of foreign-born subjects and 45.5 % of natives. Foreign-born cases were significantly younger than natives (33.9 vs 62.2 years, p<0.01). The proportion of foreign-born cases increased from 57.1% to 78.9% over the study period (2009-2017). Antibiotic resistance profile was available in 134 cases (80.2%). 32/96 foreign-born and 14/38 native subjects presented drug resistant TB (p > 0.05). All multidrug-resistant (MDR) (2/134) and extensively-resistant (XDR) (1/134) cases were East-European and smear negative cases. We did not observe any increasing or decreasing trend in drug resistance profile over the 8 year study period (Figure 1). However, even if not statistically significant, we found an association with the country of birth: East-Europeans presented the higher rate of drug resistant cases (44.1%), Asians, the lower (23.8%). Conclusions: In a low TB burden setting, TB cases cluster mostly among foreign-born subjects and are generally sensitive to first-line drugs. In our series, most of drug-resistant cases, all MDR and XDR cases were recorded among East-Europeans. Drug-resistance rate is not increasing and its profile reflects those of the country of birth and may vary with the variation of immigration flows.

Drug Resistant Tuberculosis Among Foreigners and Natives in a City of Northern Italy. A Retrospective Study Period of Eight Years.

Di Nuzzo, Mariachiara
Primo
Writing – Original Draft Preparation
;
Maritati, Martina
Membro del Collaboration Group
;
Grilli, Anastasio
Membro del Collaboration Group
;
Contini, Carlo
Ultimo
Supervision
2018

Abstract

Background: Drug-resistant tuberculosis (TB) represents a threat in TB control, because of cumbersome clinical management, toxicity and prolonged treatment. Drug resistance trend in Emilia-Romagna, a region of Northern Italy, is not increasing and in 2016 is even decreased. The present study describes the TB epidemiological and anti-TB drug resistance trend among natives and foreign-born cases between 2009 and 2017, in a low TB burden and high immigrant receiving setting (Ferrara, a city of Northern Italy, Emilia-Romagna region). Methods: We retrospectively identified all bacteriologically confirmed TB cases (confirmed by NAAT or culture) diagnosed in Ferrara University-Hospital from 2009 to 2017. We recorded gender, age, country of birth, site of disease, smear positivity, sensitivity or resistance toward one (mono-resistant), two or more first-line anti-TB drug (poly-resistant), MDR, and XDR-TB. Results: 109 out of the 167 TB cases (65.3%) were foreign-born and 58 natives, 95 males and 72 females, 120 pulmonary (PTB) and 47 extra-pulmonary (EPTB) cases. Among PTB cases, a positive smear was recorded in 56.6 % of foreign-born subjects and 45.5 % of natives. Foreign-born cases were significantly younger than natives (33.9 vs 62.2 years, p<0.01). The proportion of foreign-born cases increased from 57.1% to 78.9% over the study period (2009-2017). Antibiotic resistance profile was available in 134 cases (80.2%). 32/96 foreign-born and 14/38 native subjects presented drug resistant TB (p > 0.05). All multidrug-resistant (MDR) (2/134) and extensively-resistant (XDR) (1/134) cases were East-European and smear negative cases. We did not observe any increasing or decreasing trend in drug resistance profile over the 8 year study period (Figure 1). However, even if not statistically significant, we found an association with the country of birth: East-Europeans presented the higher rate of drug resistant cases (44.1%), Asians, the lower (23.8%). Conclusions: In a low TB burden setting, TB cases cluster mostly among foreign-born subjects and are generally sensitive to first-line drugs. In our series, most of drug-resistant cases, all MDR and XDR cases were recorded among East-Europeans. Drug-resistance rate is not increasing and its profile reflects those of the country of birth and may vary with the variation of immigration flows.
Drug-resistant tuberculosis, TB, bacteriologically confirmed TB cases, first-line anti-TB drug, MDR, XDR-TB, Ferrara, low TB burden setting, Emilia-Romagna, immigrants, foreign-born cases
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11392/2382923
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