{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T10:50:32Z","timestamp":1765795832740,"version":"3.48.0"},"reference-count":29,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T00:00:00Z","timestamp":1765756800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Direcci\u00f3n General de Investigaciones of Universidad Santiago de Cali","award":["DGI-01-2025"],"award-info":[{"award-number":["DGI-01-2025"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["TropicalMed"],"abstract":"<jats:p>Background: Drug-resistant tuberculosis (DR-TB) constitutes a serious threat to global public health due to the increase in strains resistant to multiple drugs, especially isoniazid and rifampicin. This resistance increases mortality, estimated at 25.6% globally, and complicates treatments due to its high toxicity and cost. Materials and Methods: A quantitative ecological study was carried out with data on drug-resistant tuberculosis reported in Sivigila in the years (2020\u20132023) SIVIGILA database. 1694 cases were analyzed, considering sociodemographic variables such as age, sex, nationality and prioritized population groups. Departmental rates per 100,000 inhabitants were calculated with DANE projection, from these choropleth maps were developed. Applying a Kulldorff spatial scan under a Poisson model using the SMERC package of R (version 4.5.1), with windows centered on each department and Monte Carlo simulation contrast to identify high-risk clusters (RR &gt; 1). Results: (DR-TB) Predominantly in men aged 30\u201344 years, with a progressive increase until 2023 (IRR = 2.11). Three high-risk clusters were detected in the southwest and center of the country. Discussion: Drug-resistant tuberculosis in Colombia showed a sustained increase in the years of study, with a cumulative increase of 110% compared to 2020, associated with economically active people more exposed due to occupational and social factors. The greatest burden was observed in the general population. Cases also increased in groups with social and health vulnerability conditions. Conclusions: The departments of Risaralda, Meta, and Valle del Cauca presented the highest drug resistance rates in Colombia.<\/jats:p>","DOI":"10.3390\/tropicalmed10120351","type":"journal-article","created":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T10:11:23Z","timestamp":1765793483000},"page":"351","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Spatial Analysis of Drug-Resistant Tuberculosis in Colombia (2020\u20132023): Departmental Rates, Clusters, and Associated Factors"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6932-0980","authenticated-orcid":false,"given":"Brayan","family":"Pati\u00f1o-Palma","sequence":"first","affiliation":[{"name":"Faculty of Health and Sports Sciences, Fundaci\u00f3n Universitaria del \u00c1rea Andina, Pereira 660004, Colombia"},{"name":"Faculty of Health, Universidad Aut\u00f3noma de Manizales, Manizales 170004, Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-2196-8190","authenticated-orcid":false,"given":"Sandra","family":"Chacon-Bambague","sequence":"additional","affiliation":[{"name":"Faculty of Health and Sports Sciences, Fundaci\u00f3n Universitaria del \u00c1rea Andina, Pereira 660004, Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6587-8939","authenticated-orcid":false,"given":"Farlhyn","family":"Bermudez-Moreno","sequence":"additional","affiliation":[{"name":"Faculty of Health and Sports Sciences, Fundaci\u00f3n Universitaria del \u00c1rea Andina, Pereira 660004, Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9958-041X","authenticated-orcid":false,"given":"Carmencita","family":"Pe\u00f1a-Brice\u00f1o","sequence":"additional","affiliation":[{"name":"Faculty of Health and Sports Sciences, Fundaci\u00f3n Universitaria del \u00c1rea Andina, Pereira 660004, Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4155-9703","authenticated-orcid":false,"given":"Juan","family":"Bustos-Carvajal","sequence":"additional","affiliation":[{"name":"Universidad de Pamplona, Pamplona 540004, Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3779-5498","authenticated-orcid":false,"given":"Florencio","family":"Arias-Coronel","sequence":"additional","affiliation":[{"name":"Faculty of Health, Universidad Santiago de Cali, Cali 760035, Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Rahlwes, K.C., Dias, B.R.S., Campos, P.C., Alvarez-Arguedas, S., and Shiloh, M.U. (2023). Pathogenicity and virulence of Mycobacterium tuberculosis. Virulence, 14.","DOI":"10.1080\/21505594.2022.2150449"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Farina, E., D\u2019Amore, C., Lancella, L., Boccuzzi, E., Ciofi degli Atti, M.L., Reale, A., Rossi, P., Villani, A., Raponi, M., and Raucci, U. (2022). Alert signs and symptoms for the early diagnosis of pulmonary tuberculosis: Analysis of patients followed by a tertiary pediatric hospital. Ital. J. Pediatr., 48.","DOI":"10.1186\/s13052-022-01288-5"},{"key":"ref_3","unstructured":"World Health Organization (2022). WHO Consolidated Guidelines on Tuberculosis. Module 4: Treatment\u2014Drug-Resistant Tuberculosis. 2022 Update, World Health Organization. Available online: https:\/\/www.who.int\/publications\/i\/item\/9789240063129."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Cui, K., Zhao, X., Liu, W., and Bai, L. (2025). Global, regional, and national burden and trends of multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis in adolescents and adults aged 15\u201349 years from 2010 to 2021: Insights from the Global Burden of Disease Study 2021. BMC Med., 23.","DOI":"10.1186\/s12916-025-04269-7"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Alemu, A., Bitew, Z.W., Worku, T., Gamtesa, D.F., and Alebel, A. (2021). Predictors of mortality in patients with drug-resistant tuberculosis: A systematic review and meta-analysis. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0253848"},{"key":"ref_6","unstructured":"World Health Organization (2025, August 09). Tuberculosis. Available online: https:\/\/www.who.int\/es\/news-room\/fact-sheets\/detail\/tuberculosis."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Yang, H., Ruan, X., Li, W., Xiong, J., and Zheng, Y. (2024). Global, regional, and national burden of tuberculosis and attributable risk factors for 204 countries and territories, 1990\u20132021: A systematic analysis for the Global Burden of Diseases 2021 study. BMC Public Health, 24.","DOI":"10.1186\/s12889-024-20664-w"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Xue, Y., Zhou, J., Wang, P., Lan, J.H., Lian, W.Q., Fan, Y.Y., Xu, B.-N., Yin, J.-P., Feng, Z.-H., and Zhou, J. (2022). Burden of tuberculosis and its association with socioeconomic development status in 204 countries and territories, 1990\u20132019. Front. Med., 9.","DOI":"10.3389\/fmed.2022.905245"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Chen, Y., Chen, W., Cheng, Z., Chen, Y., Li, M., Ma, L., Zhou, N., Qian, J., Zhu, Y., and Liu, C. (2024). Global burden of HIV-negative multidrug- and extensively drug-resistant tuberculosis based on Global Burden of Disease Study 2021. Sci. One Health, 3.","DOI":"10.1016\/j.soh.2024.100072"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Salari, N., Kanjoori, A.H., Hosseinian-Far, A., Hasheminezhad, R., Mansouri, K., and Mohammadi, M. (2023). Global prevalence of drug-resistant tuberculosis: A systematic review and meta-analysis. Infect. Dis. Poverty, 12.","DOI":"10.1186\/s40249-023-01107-x"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Mej\u00eda-Ponce, P.M., Ramos-Gonz\u00e1lez, E.J., Ramos-Garc\u00eda, A.A., Lara-Ram\u00edrez, E.E., Soriano-Herrera, A.R., Medell\u00edn-Luna, M.F., Valdez-Salazar, F., Castro-Garay, C.Y., N\u00fa\u00f1ez-Contreras, J.J., and De Donato-Capote, M. (2023). Genomic epidemiology analysis of drug-resistant Mycobacterium tuberculosis distributed in Mexico. PLoS ONE, 18.","DOI":"10.1371\/journal.pone.0292965"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Castro-Rodriguez, B., Franco-Sotomayor, G., Benitez-Medina, J.M., Cardenas-Franco, G., Jim\u00e9nez-Pizarro, N., Cardenas-Franco, C., Aguirre-Martinez, J.L., Orlando, S.A., de Mendoza, J.H., and Garcia-Bereguiain, M.A. (2024). Prevalence, drug resistance, and genotypic diversity of the RDRio subfamily of Mycobacterium tuberculosis in Ecuador: A retrospective analysis for years 2012\u20132016. Front. Public Health, 12.","DOI":"10.3389\/fpubh.2024.1337357"},{"key":"ref_13","unstructured":"Instituto Nacional de Salud (2025, June 19). Informe de Evento Tuberculosis, Colombia, 2022, Available online: https:\/\/www.ins.gov.co\/buscador-eventos\/Informesdeevento\/TUBERCULOSIS%20INFORME%202022.pdf."},{"key":"ref_14","first-page":"999","article-title":"Risk factors and predictors of drug resistance in tuberculosis: A comprehensive analysis of cases in Chile (2014\u20132018)","volume":"151","author":"Orostica","year":"2023","journal-title":"Rev. Med. Chil."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Wu, I.L., Chen, J., Shiau, R., Chitnis, A.S., and Jaganath, D. (2022). Tuberculosis disease among adults aged 65 years and older: Alameda County, California, 2016\u20132019. Open Forum Infect. Dis., 9.","DOI":"10.1093\/ofid\/ofac575"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/j.jgar.2024.09.002","article-title":"Age and gender in drug-resistant tuberculosis: A cross-sectional case study at a national tuberculosis reference hospital in Nigeria","volume":"39","author":"Madaki","year":"2024","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Peer, V., Schwartz, N., and Green, M.S. (2023). Gender differences in tuberculosis incidence rates: A pooled analysis of data from seven high-income countries by age group and time period. Front. Public Health, 10.","DOI":"10.3389\/fpubh.2022.997025"},{"key":"ref_18","unstructured":"Organizaci\u00f3n Panamericana de la Salud (2025, August 09). Tuberculosis en las Am\u00e9ricas: Informe Regional 2021. Available online: https:\/\/iris.paho.org\/handle\/10665.2\/57001."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Meaza, A., Tola, H.H., Eshetu, K., Mindaye, T., Medhin, G., and Gumi, B. (2022). Tuberculosis among refugees and migrant populations: Systematic review. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0268696"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Kunst, H., Lange, B., Hovardovska, O., Bockey, A., Zenner, D., Andersen, A.B., Hargreaves, S., Pareek, M., Friedland, J.S., and Wejse, C. (2025). Tuberculosis in adult migrants in Europe: A TBnet consensus statement. Eur. Respir. J., 65.","DOI":"10.1183\/13993003.01612-2024"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Santos, M.S., Pieri, F.M., Berra, T.Z., Scholze, A.R., Ramos, A.C.V., de Almeida Crispim, J., Giacomet, C.L., Alves, Y.M., da Costa, F.B.P., and Moura, H.S.D. (2022). Acquired and transmitted multidrug-resistant tuberculosis among the incarcerated population and its determinants in the State of Paran\u00e1, Brazil. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph192214895"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e6","DOI":"10.1016\/S2214-109X(18)30525-4","article-title":"Determinants of tuberculosis in Indigenous people worldwide","volume":"7","author":"Basta","year":"2019","journal-title":"Lancet Glob. Health"},{"key":"ref_23","unstructured":"Villegas Salazar, T.T., Tegaisa, L.V., and Sarmiento, J.M.H. (2025, August 09). Tuberculosis in Indigenous Communities of Choc\u00f3, Colombia: Epidemiological Analysis and Perspectives to Reduce Its Incidence. Available online: https:\/\/www.amimc.org.mx\/wp-content\/uploads\/2019\/04\/EIM4w.pdf#page=6."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Khojasteh-Kaffash, S., Habibzadeh, A., Moghaddam, S., Afra, F., Samieefar, N., and Fateh, A. (2025). Tuberculosis trends in the post-COVID-19 era: Is it going to be a global concern?. Health Sci. Rep., 8.","DOI":"10.1002\/hsr2.70792"},{"key":"ref_25","unstructured":"World Health Organization (2025, August 09). Global Tuberculosis Report 2024. Available online: https:\/\/www.who.int\/teams\/global-programme-on-tuberculosis-and-lung-health\/tb-reports\/global-tuberculosis-report-2024."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"122","DOI":"10.7180\/kmj.25.105","article-title":"Resurgence of multidrug-resistant tuberculosis during the COVID-19 pandemic in Korea","volume":"40","author":"Kim","year":"2025","journal-title":"Kosin Med. J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1395","DOI":"10.1016\/S1473-3099(23)00372-9","article-title":"Burden of tuberculosis among vulnerable populations worldwide: An overview of systematic reviews","volume":"23","author":"Litvinjenko","year":"2023","journal-title":"Lancet Infect. Dis."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Fofana, A.M., Moultrie, H., Scott, L., Jacobson, K.R., Shapiro, A.N., Dor, G., Crankshaw, B., Da Silva, P., Jenkins, H.E., and Bor, J. (2023). Cross-municipality migration and spread of tuberculosis in South Africa. Sci. Rep., 13.","DOI":"10.1038\/s41598-023-29804-5"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.3390\/idr16060095","article-title":"Drug-resistant tuberculosis hotspots in Oliver Reginald Tambo District Municipality, Eastern Cape, South Africa","volume":"16","author":"Faye","year":"2024","journal-title":"Infect. Dis. 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