Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2006 Feb;61(2):158-63.
doi: 10.1136/thx.2005.045963. Epub 2005 Oct 27.

Risk factors for multidrug resistant tuberculosis in Europe: a systematic review

A Faustini  1 , A J Hall, C A Perucci
Affiliations
Meta-Analysis

Risk factors for multidrug resistant tuberculosis in Europe: a systematic review

A Faustini et al. Thorax. 2006 Feb.

Abstract

Background: The resurgence of tuberculosis (TB) in western countries has been attributed to the HIV epidemic, immigration, and drug resistance. Multidrug resistant tuberculosis (MDR-TB) is caused by the transmission of multidrug resistant Mycobacterium tuberculosis strains in new cases, or by the selection of single drug resistant strains induced by previous treatment. The aim of this report is to determine risk factors for MDR-TB in Europe.

Methods: A systematic review was conducted of published reports of risk factors associated with MDR-TB in Europe. Meta-analysis, meta-regression, and sub-grouping were used to pool risk estimates of MDR-TB and to analyse associations with age, sex, immigrant status, HIV status, occurrence year, study design, and area of Europe.

Results: Twenty nine papers were eligible for the review from 123 identified in the search. The pooled risk of MDR-TB was 10.23 times higher in previously treated than in never treated cases, with wide heterogeneity between studies. Study design and geographical area were associated with MDR-TB risk estimates in previously treated patients; the risk estimates were higher in cohort studies carried out in western Europe (RR 12.63; 95% CI 8.20 to 19.45) than in eastern Europe (RR 8.53; 95% CI 6.57 to 11.06). National estimates were possible for six countries. MDR-TB cases were more likely to be foreign born (odds ratio (OR) 2.46; 95% CI 1.86 to 3.24), younger than 65 years (OR 2.53; 95% CI 1.74 to 4.83), male (OR 1.38; 95% CI 1.16 to 1.65), and HIV positive (OR 3.52; 95% CI 2.48 to 5.01).

Conclusions: Previous treatment was the strongest determinant of MDR-TB in Europe. Detailed study of the reasons for inadequate treatment could improve control strategies. The risk of MDR-TB in foreign born people needs to be re-evaluated, taking into account any previous treatment.

PubMed Disclaimer

Conflict of interest statement

Competing interests: none declared.

References

    1. Centres for Diseases Control Tuberculosis: United States. First 39 weeks, 1985. MMWR 198534625–627. - PubMed
    1. Raviglione M, Sudre P, Rieder H L.et al Secular trends of tuberculosis in Western Europe. WHO Bull 199371293–306. - PMC - PubMed
    1. Rieder H L, Cauthen G M, Comstock G W.et al Epidemiology of tuberculosis in the United States. Epidemiol Rev 19891179–98. - PubMed
    1. McKenna M T, McCray E, Onorato I. The epidemiology of tuberculosis among foreign‐born persons in the United States, 1986–1993. N Engl J Med 19953221071–1076. - PubMed
    1. Frieden T R, Sterling T, Pablos‐Mendez A.et al The emergence of drug‐resistant tuberculosis in New York City. N Eng J Med 1993328521–526. - PubMed