This study analyzes 31-year trends in tuberculosis drug resistance and associated factors, revealing immigration and retreatment as primary drivers of increasing resistance. It provides critical epidemiological data for tuberculosis control.
Literature Overview
This article titled 'Trends in Antituberculosis Drug Resistance and Associated Factors: A 31-Year Observational Study at a Tertiary Hospital in Barcelona', published in the journal Antibiotics, reviews changes in tuberculosis drug resistance rates between 1991 and 2022. It examines sociodemographic factors influencing resistance development and provides essential evidence for tuberculosis control strategies.
Background Knowledge
Tuberculosis (TB), caused by Mycobacterium tuberculosis, remains one of the top ten fatal diseases globally. The emergence of drug-resistant TB (DR-TB) complicates treatment and worsens prognosis, with multidrug-resistant (MDR-TB) and rifampicin-resistant (RR-TB) forms requiring prolonged therapy cycles, facing significant drug toxicity, and showing limited efficacy. Based on long-term data from a Barcelona tertiary hospital, this study investigates resistance evolution patterns with particular focus on immigration and retreatment impacts. Research scope includes TB treatment standards, resistance mechanisms, molecular epidemiology, and public health control strategies. While TB incidence declines, transmission of resistant strains, poor treatment adherence, and genetic mutations persist as public health challenges. This study provides critical epidemiological insights for monitoring DR-TB and implementing personalized treatments in low-incidence regions.
Research Methods and Experiments
This retrospective observational study included 2,448 TB-diagnosed patients from 1991–2022, excluding 86 cases with incomplete data. Using WHO's latest guidelines, drug resistance was categorized into five types: monoresistance (mDR), polyresistance (pDR), and extensively drug-resistant (XDR). Data sources included hospital microbiology departments and the Barcelona Public Health Agency. The study period was divided into 1991–2000 and 2001–2022. Linear regression analyzed resistance trends, with chi-square tests and Mann-Whitney U tests comparing proportion differences and median variations. Multivariate regression assessed resistance-associated factors including birthplace, treatment history, and socioeconomic status.
Key Conclusions and Perspectives
Research Significance and Prospects
The study emphasizes the necessity of continuous drug susceptibility testing, access to second-line therapies, and public health interventions targeting high-risk populations in low-incidence regions to combat potential DR-TB spread. Future research should expand to multi-center studies to validate these trends, incorporating molecular epidemiology to trace transmission pathways and genetic variations. Further assessments of resistant strains' response to novel treatments like bedaquiline and pretomanid could optimize personalized therapeutic strategies.
Conclusion
Through 31-year observation, this study reveals rising TB drug resistance rates in Barcelona despite declining multidrug resistance. Resistance increases primarily originate from foreign-born and retreatment cases. Findings highlight the central role of drug susceptibility testing in TB management, identifying immigration and treatment adherence as critical resistance control factors. While overall TB incidence decreases, persistent transmission of resistant strains remains a public health challenge. Strengthened resistance monitoring, optimized treatment protocols, and enhanced interventions for high-risk populations are required to meet WHO 2025 control targets. The study provides essential data support for DR-TB prevention in low-incidence regions and suggests integrating genomic sequencing and animal models for further resistance mechanism research.
