Antituberculosis drug resistance in immigrants to Alberta, Canada, with tuberculosis, 1982-1994

Int J Tuberc Lung Dis. 1997 Jun;1(3):225-30.

Abstract

Setting: Provincial Tuberculosis Service, Alberta, Canada.

Objective: To estimate resistance rates of Mycobacterium tuberculosis to antituberculosis drugs in relation to previous treatment, country of origin, age and duration of residence in Canada.

Design: Retrospective chart review of all culture-positive tuberculosis diagnosed between 1982 and 1994 in immigrants to Alberta.

Results: A total of 753 immigrants with culture-positive tuberculosis were studied; 131 patients (17.4%, 95% Confidence Interval [CI] 14.7, 20.1) had strains resistant to one or more of the first-line medications (isoniazid [INH], rifampin [RIF], ethambutol [EMB], pyrazinamide [PZA], and streptomycin [SM]). Initial and secondary resistance rates were 16.4% and 30.3%, respectively (P = 0.003, Odds ratio [OR] 2.2, 95% CI 1.3, 3.8). Resistance occurred in 22.2% of patients 40 years of age and under, and in 13.8% of those over 40 years of age (P = 0.005, OR 1.8, 95% CI 1.2, 2.6). Resistant M. tuberculosis was isolated from 20.4% of those who had lived in Canada for less than 15 years, and in 9.0% of those who had immigrated to Canada more than 15 years before diagnosis (P < 0.001; OR 2.4, 95% CI 1.3, 4.2). Resistance rates to individual medications in all immigrants were as follows: INH 9.9% (95% CI 7.8, 12.0), RIF 0.8% (95% CI 0.2, 1.4), EMB 1.9% (95% CI 1.0, 2.8), PZA 1.9% (95% CI 0.3, 3.5), and SM 12.9% (95% CI 10.4, 15.4). Immigrants from Vietnam, China, and the Philippines had tuberculosis strains that were resistant to one or more of the first line medications in 30.2%, 21.8%, and 15.5% of cases, respectively (P = 0.04).

Conclusion: In industrialized countries such as Canada where most cases of tuberculosis are diagnosed among the foreign-born, drug resistance surveys continue to be an important part of an effective tuberculosis control program.

MeSH terms

  • Adolescent
  • Adult
  • Alberta / epidemiology
  • Antitubercular Agents / therapeutic use
  • Asia / ethnology
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Emigration and Immigration / statistics & numerical data*
  • Ethnic Groups / statistics & numerical data*
  • Female
  • Humans
  • Incidence
  • Infant
  • Male
  • Microbial Sensitivity Tests
  • Mycobacterium tuberculosis / drug effects
  • Retrospective Studies
  • Tuberculosis, Multidrug-Resistant / epidemiology
  • Tuberculosis, Multidrug-Resistant / ethnology*
  • Tuberculosis, Multidrug-Resistant / prevention & control

Substances

  • Antitubercular Agents