{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T10:30:39Z","timestamp":1791282639153,"version":"4.1.0"},"reference-count":11,"publisher":"European Respiratory Society (ERS)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Eur Respir J"],"accepted":{"date-parts":[[2007,7,23]]},"published-print":{"date-parts":[[2007,10]]},"abstract":"<jats:p>Currently, no information is available on the effect of resistance\/susceptibility to first-line drugs different from isoniazid and rifampicin in determining the outcome of extensively drug-resistant tuberculosis (XDR-TB) patients, and whether being XDR-TB is a more accurate indicator of poor clinical outcome than being resistant to all first-line anti-tuberculosis (TB) drugs.<\/jats:p><jats:p>To investigate this issue, a large series of multidrug-resistant TB (MDR-TB) and XDR-TB cases diagnosed in Estonia, Germany, Italy and the Russian Federation during the period 1999\u20132006 were analysed. Drug-susceptibility testing for first- and second-line anti-TB drugs, quality assurance and treatment delivery was performed according to World Health Organization recommendations in all study sites.<\/jats:p><jats:p>Out of 4,583 culture-positive TB cases analysed, 361 (7.9%) were MDR and 64 (1.4%) were XDR. XDR-TB cases had a relative risk (RR) of 1.58 to have an unfavourable outcome compared with MDR-TB cases resistant to all first-line drugs (isoniazid, rifampicin ethambutol, streptomycin and, when tested, pyrazinamide), and an RR of 2.61 compared with \u201cother\u201d MDR-TB cases (those susceptible to at least one first-line anti-TB drug among ethambutol, pyrazinamide and streptomycin, regardless of resistance to the second-line drugs not defining XDR-TB).<\/jats:p><jats:p>The emergence of extensively drug-resistant tuberculosis confirms that problems in tuberculosis management are still present in Europe. While waiting for new tools which will facilitate management of extensively drug-resistant tuberculosis, accessibility to quality diagnostic and treatment services should be urgently ensured and adequate public health policies should be rapidly implemented to prevent further development of drug resistance.<\/jats:p>","DOI":"10.1183\/09031936.00077307","type":"journal-article","created":{"date-parts":[[2007,8,10]],"date-time":"2007-08-10T00:19:42Z","timestamp":1186705182000},"page":"623-626","source":"Crossref","is-referenced-by-count":145,"title":["Clinical and operational value of the extensively drug-resistant tuberculosis definition"],"prefix":"10.1183","volume":"30","author":[{"given":"G. 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C.","family":"Raviglione","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"81","published-online":{"date-parts":[[2007,8,9]]},"reference":[{"key":"2024102019221811000_30.4.623.1","first-page":"430","volume":"81","year":"2006","journal-title":"Weekly Epidemiol Rec"},{"key":"2024102019221811000_30.4.623.2","first-page":"301","volume":"55","year":"2006","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2024102019221811000_30.4.623.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(06)69573-1"},{"key":"2024102019221811000_30.4.623.4","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00001307"},{"key":"2024102019221811000_30.4.623.5","doi-asserted-by":"crossref","unstructured":"Migliori GB, Ortmann J, Girardi E, et al. Extensively drug-resistant tuberculosis, Italy and Germany. Emerging Infectious Diseases. www.cdc.gov\/EID\/content\/13\/5\/780.htm. Date last updated: June 25, 2007. 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