ArticlePloS one2019
First-line tuberculosis drug resistance patterns and associated risk factors in Germany, 2008-2017.
Article in PloS one, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 4 of them syntheses that pooled it.
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Who cites it
23 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Tuberculosis in adult migrants in Europe: a TBnet consensus statement.The European respiratory journal · 2025Pooled it
- Treatment of MDR, Pre-XDR, XDR, and Rifampicin-Resistant Tuberculosis or in Case of Intolerance to at Least Rifampicin in Austria, Germany, and Switzerland.Respiration; international review of thoracic diseases · 2024Guideline
- Risk factors for multidrug-resistant tuberculosis: A worldwide systematic review and meta-analysis.PloS one · 2022Pooled it
- Drug-Resistant Tuberculosis Among Children: A Systematic Review and Meta-Analysis.Frontiers in public health · 2021Pooled it
- Trial
- Risk factors of multi-drug-resistant tuberculosis among tuberculosis patients in Bagmati Province, Nepal: a matched case-control study.BMC infectious diseases · 2026Article
- Pattern and predictors of drug resistance and treatment outcome in tuberculosis patients at the centers of programmatic management of drug-resistant tuberculosis in Lahore, Pakistan.BMC public health · 2026Article
- Risk factors and prediction modeling for drug-resistant tuberculosis in Shenzhen: a 9-year retrospective study.Frontiers in public health · 2026Article
- Animals as overlooked victims and vectors of tuberculosis: review ofOne health advances · 2026Review
- Drug resistance among students with pulmonary tuberculosis: a study based on screening in Henan, China.BMC infectious diseases · 2025Article
- Drug-resistant tuberculosis treatment success predictors in Namibia.JAC-antimicrobial resistance · 2024Article
- Pediatric multi-drug-resistant tuberculosis in Germany - diagnostic and therapeutic challenges of an "orphan disease".European journal of pediatrics · 2023Article
- Resistance patterns and transmission of mono- and polyresistant TB: clinical impact of WGS.JAC-antimicrobial resistance · 2023Article
- Prevalence ofJournal of clinical tuberculosis and other mycobacterial diseases · 2023Article
- Article
- Distribution ofTropical medicine and infectious disease · 2022Article
- Review
- Review
- A Saudi Arabian Public Health Perspective of Tuberculosis.International journal of environmental research and public health · 2021Review
- Prevalence of primary anti-tuberculosis drug resistance at the tertiary center in Saudi Arabia and associated risk factors.Saudi medical journal · 2021Article
Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundDrug-resistant tuberculosis (TB), especially multidrug-resistant TB (MDR-TB), poses a threat to public health. While standard surveillance focuses on Rifampicin and/or Isoniazid resistance, little is known about other resistance patterns. This study aims to identify predominant drug resistance (DR) patterns in Germany and risk factors associated with them in order to inform diagnostic and treatment strategies.
methodsCase-based TB surveillance data notified in Germany from 2008-2017 were utilized to investigate DR and MDR-TB patterns for Isoniazid (H), Rifampicin (R), Pyrazinamide (Z), Ethambutol (E), and Streptomycin (S). Predominant patterns were further analyzed stratified by sex, age, country of birth, prior TB, and disease site. Multivariable logistic regression was conducted to determine risk factors associated with any resistance, MDR-TB, and complete HRZES resistance.
results26,228 cases with complete DST results were included in the study, among which 3,324 cases had any DR (12.7%). Four patterns were predominant, representing about ¾ of all cases with any resistance (S: 814 [3.1%]; H: 768 [2.9%]; HS: 552 [2.1%]; Z: 412 [1.6%]). High proportions of S and H resistances were found among both German and foreign-born populations, especially those born in Eastern Europe, and were unexpectedly high among children (H: 4.3%; S: 4.6%). Foreign-born cases had significantly higher proportion of any resistance (16.0%) and MDR-TB (3.3%) compared to German-born cases (8.3% and 0.6%). Of 556 MDR-TB cases, 39.2% showed complete HRZES resistance. Logistic regression revealed having prior TB and being foreign-born as consistently strong risk factors for any DR, MDR-TB, and complete HRZES resistance.
conclusionsDR patterns observed in Germany, particularly for MDR-TB were more complex than expected, highlighting the fact that detailed drug-testing results are crucial before incorporating HRZES drugs in MDR-TB treatment. Furthermore, the relatively high rate of H-resistance in Germany provides strong rationale against the use of only H-based preventive therapy for LTBI.
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