Epidemiology and Surveillance, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
Euro Surveill. 2014 Mar 20;19(11):20738. doi: 10.2807/1560-7917.es2014.19.11.20738.
The elimination of tuberculosis (TB) is threatened by an apparent increase in the level of resistance in Mycobacterium tuberculosis. In the Netherlands, where the majority of TB patients are migrants, resistance may also be increasing. We conducted a retrospective study, using 18,294 M. tuberculosis isolates from TB cases notified between 1993 and 2011. We investigated the trends in antituberculosis drug resistance, focusing on the country of birth of the patients and whether resistance had developed during treatment or was the result of transmission of resistant M. tuberculosis strains. For both scenarios, we determined whether this had happened in or outside the Netherlands. Antituberculosis drug resistance was found in 13% of all cases analysed and showed an increasing trend among patients who had been born in the Netherlands (p<0.001) and a decreasing trend among foreign-born (p=0.02) over the study period. Since 2005, the proportion of M. tuberculosis resistant strains among all strains tested has increased in both groups (p=0.03 and p=0.01, respectively). Overall, we found a significantly increasing trend when excluding streptomycin resistance (p<0.001). The trend was most markedly increased for isoniazid resistance (p = 0.01). Although resistance was mainly due to transmission of resistant strains, mostly outside the Netherlands or before 1993 (when DNA fingerprinting was not systematically performed), in some cases (n=45), resistance was acquired in the Netherlands. We conclude that antituberculosis drug resistance is increasing in the Netherlands, mostly related to migration from high TB-incidence countries, but also to domestic acquisition.
结核病（TB）的消除受到结核分枝杆菌耐药水平明显上升的威胁。在荷兰，大多数结核病患者是移民，耐药性也可能在增加。我们进行了一项回顾性研究，使用了 1993 年至 2011 年间报告的结核病病例中的 18294 株结核分枝杆菌分离株。我们调查了抗结核药物耐药性的趋势，重点关注患者的出生地以及耐药性是在治疗过程中产生的还是耐药结核分枝杆菌株传播的结果。对于这两种情况，我们确定这种情况是在荷兰境内还是境外发生的。在分析的所有病例中，发现 13%的病例存在抗结核药物耐药性，在荷兰出生的患者中呈上升趋势（p<0.001），在外国出生的患者中呈下降趋势（p=0.02）。研究期间，自 2005 年以来，在两组患者中，所有测试的结核分枝杆菌菌株中耐药菌株的比例都有所增加（分别为 p=0.03 和 p=0.01）。总体而言，在排除链霉素耐药性后，我们发现了一个显著的上升趋势（p<0.001）。异烟肼耐药性的趋势最为明显（p=0.01）。尽管耐药性主要是由于耐药菌株的传播，主要是在荷兰境外或 1993 年之前（当时没有系统地进行 DNA 指纹分析），但在某些情况下（n=45），耐药性是在荷兰获得的。我们的结论是，荷兰的抗结核药物耐药性正在增加，主要与来自高结核病发病率国家的移民有关，但也与国内获得有关。
