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Monitoring the quality of laboratories and the prevalence of resistance to antituberculosis drugs: Italy, 1998–2000

¹ World Health Organization (WHO) Collaborating Centre for Tuberculosis and Lung Diseases, Dept of Pneumonology, S. Maugeri Foundation, Care and Research Institute, Tradate, ² Supranational Reference Laboratory, Dept of Bacteriology and Medical Micology, Istituto Superiore di Sanità, Rome, ⁴ National Reference Laboratory, Villa Marelli Institute, Milan, ³ Tuberculosis Dept, E. Morelli Hospital, Sondalo, ⁵ Division of Respiratory Diseases, University Tor Vergata, L. Spallanzani Hospital, Rome, ⁶ Dept of Clinical Microbiology, General Hospital Umberto I-Torrette, Ancona and ⁷ Institute of Infectious Diseases, Sacco Hospital, University of Milano, Milan, Italy

CORRESPONDENCE: G.B. Migliori, WHO Collaborating Centre for Tuberculosis and Lung Diseases, Fondazione Salvatore Maugeri, via Roncaccio, 16, 21049, Tradate (VA), Italy. Fax: 39 0331829402. E-mail: gbmigliori@fsm.it

Keywords: drug, immigrant, prevalence of resistance, proficiency testing, susceptibility testing, tuberculosis

Received: June 3, 2002
Accepted September 25, 2002

This study was supported by grants from Istituto Superiore di Sanità, Rome, (National Tuberculosis Project), from the WHO and from AIPO, Grant No. TBC1.

In 1998 a network of 20 regional tuberculosis (TB) laboratories (the Italian Multicentre Study on Resistance to Antituberculosis drugs (SMIRA) network) was established in Italy to implement proficiency testing and to monitor the prevalence of drug resistance nationwide. The network managed 30% of all TB cases reported in Italy each year.

The aim of the present report is to describe: 1) the accuracy of drug-susceptibility testing in the network; 2) the prevalence of drug resistance for the period 1998–2000.

Data were collected from the network laboratories. Sensitivity to streptomycin and ethambutol increased from the first survey (1998–1999) to the second survey (2000) from 87.7 to 91.9%. Specificity, predictive values for resistance and susceptibility, efficiency and reproducibility were consistent in both surveys. In previously untreated cases, the prevalence of multidrug-resistance was the same in both surveys (1.2%), while a slight decrease from the first to the second survey was observed for monoresistance to rifampicin (from 0.8 to 0.4%) and isoniazid (from 2.9 to 2%).

The significant association found between isoniazid resistance and immigration is a useful indicator for both clinicians managing individual tuberculosis cases and public health services planning control strategies.

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