%0 Journal Article %A Migliori, G. B. %A Besozzi, G. %A Girardi, E. %A Kliiman, K. %A Lange, C. %A Toungoussova, O. S. %A Ferrara, G. %A Cirillo, D. M. %A Gori, A. %A Matteelli, A. %A Spanevello, A. %A Codecasa, L. R. %A Raviglione, M. C. %A SMIRA/TBNET Study Group %T Clinical and operational value of the extensively drug-resistant tuberculosis definition %D 2007 %R 10.1183/09031936.00077307 %J European Respiratory Journal %P 623-626 %V 30 %N 4 %X 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. 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 1999–2006 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. 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 “other” 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). 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. %U //www.qdcxjkg.com/content/erj/30/4/623.full.pdf