Antimicrobial resistance - Tuberculosis

Antimicrobial resistance develops when treatment regimens are not properly administered or adhered to. It can also occur as a result of biological variations in drug uptake or substandard drugs. Multidrug-resistant (MDR) TB entails resistance to at least two of the most effective TB drugs, isoniazid and rifampicin. Extensively drug-resistant (XDR) TB includes additional resistance to any fluoroquinolone, and to any of the second-line injectable TB drugs (amikacin, capreomycin and kanamycin). Treatment of M(X)DR TB lasts at least 18 months, with intake of at least five drugs at a time, involving a significantly higher risk for adverse drug effects. Costs of treatment for M(X)DR TB are much higher than costs of treatment for drug-susceptible TB.

European context

M(X)DR TB poses a serious challenge for eradicating TB in Europe. The notification rate of MDR TB in the EU/EEA region has remained unchanged and is around 0.3 per 100 000 population, with roughly 1 300 cases reported each year. Around 20% of these cases have XDR TB.

In the EU/EAA, only about 35% of MDR TB patients have a successful treatment outcome; over half of the patients die, fail to respond to treatment or stop treatment, increasing the risk of developing XDR TB, which has even worse treatment outcomes. These rates are far below the 75% treatment success target defined by the Tuberculosis action plan for the WHO European Region 2016–2020.

A qualitative study Healthcare system factors influencing treatment results of patients with multidrug-resistant tuberculosis in four EU countries has determined key factors for achieving good treatment results in patients with MDR TB across the EU/EEA:

  • Timely diagnosis of drug-resistant TB through implementation of rapid molecular drug-susceptibility testing in accordance with national guidelines.
  • Financial systems favourable for the treatment and support of multidrug-resistant TB without financial barriers for patients.
  • Intersectoral collaboration that addresses patients’ emotional and social needs as well as their clinical needs, such as treatment regimen, co-management of substance dependencies and other co-morbidities.
  • Motivated and devoted healthcare workers with sufficient mandate and means to support patients.
  • Cross-border management of multidrug-resistant TB cases with the development of collaborative mechanisms for a continuum of care between countries, including social support and reporting of treatment results.

Publication

European Union Standards for Tuberculosis Care - 2017 update

public health guidance -

Publication

Tuberculosis surveillance and monitoring in Europe, 2018

surveillance report -

Publication

Multidrug-resistant tuberculosis in migrants, multi-country cluster - 3rd update, 13 April 2017

risk assessment -

Publication

Communicable disease threats report, 9-15 April 2017, week 15

surveillance report -

Publication

Communicable disease threats report, 2–8 April 2017, week 14

surveillance report -

Publication

Multidrug-resistant tuberculosis in migrants, multi-country cluster - 3rd update, 13 April 2017

risk assessment -

Publication

Rapid risk assessment: multidrug-resistant tuberculosis in migrants, multi-country cluster - 2nd update, 27 March 2017

risk assessment -

Publication

Multidrug-resistant tuberculosis in migrants, multi-country cluster, first update 19 Dec 2016

risk assessment -

Publication

Tuberculosis surveillance and monitoring in Europe, 2018

surveillance report -

Publication

Communicable disease threats report, 9-15 April 2017, week 15

surveillance report -

Publication

Communicable disease threats report, 2–8 April 2017, week 14

surveillance report -

Publication

Tuberculosis surveillance and monitoring in Europe, 2017

surveillance report -

Publication

Molecular typing for surveillance of multidrug-resistant tuberculosis in the EU/EEA

surveillance report -

Peer-Reviewed Publication

Health system factors influencing management of multidrug-resistant tuberculosis in four European Union countries - learning from country experiences

2017

Peer-Reviewed Publication

The impact of HIV infection on treatment outcome of tuberculosis: analysis of surveillance data from nine European countries, 2010-2012

2016

Peer-Reviewed Publication

Impact of HIV infection on treatment outcome of tuberculosis in Europe

2016

Peer-Reviewed Publication

Fighting tuberculosis in the EU/EEA: Towards the new European Union standards on tuberculosis care

2016

Peer-Reviewed Publication

Migration-related tuberculosis: Epidemiology and characteristics of tuberculosis cases originating outside the European Union and European Economic Area, 2007 to 2013

2016

Data

Tuberculosis situation in Europe [2014 data]

infographic -

Data

Reported TB cases in the EU/EEA, 2008-2012

table -

Data

Reported MDR XDR TB cases in the EU/EEA, 2012

table -

Data

The burden of multidrug-resistant (MDR) and extensively drug-resistant (XDR) TB

infographic -

Data

Key messages - Drug-resistant tuberculosis

key messages