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Pediatric Drug-resistant Tuberculosis in Madrid: Family Matters

Santiago, Begoña MD*†; Baquero-Artigao, Fernando MD; Mejías, Asunción PhD§; Blázquez, Daniel MD; Jiménez, María Soledad PhD; Mellado-Peña, María José PhD‡**and the EREMITA Study Group

The Pediatric Infectious Disease Journal: April 2014 - Volume 33 - Issue 4 - p 345–350
doi: 10.1097/INF.0000000000000111
Original Studies

Background: The rates of isoniazid (INH) and multidrug-resistant (MDR) tuberculosis (TB) among European children vary between 10.4% and 3.5%. Spain is a low endemic country with reported rates of 4.9% of INH resistance and 1.3% of MDR in adults. However, data regarding patterns of TB resistance in children are scarce. Our aim is to determine the incidence and risk factors for pediatric-resistant TB in our setting to help developing age-targeted guidelines.

Methods: A multicenter, retrospective study including 22 hospitals from Madrid region (EREMITA study group) was performed from January 2005 to June 2010. Medical records from children diagnosed with TB were reviewed for demographic characteristics, clinical presentation and outcomes. Risk factors for INH and MDR TB were identified.

Results: Of 396 children diagnosed with TB, 72.4% were born to foreign parents. Microbiologic confirmation by culture (n = 200) or PCR (n = 8) was documented in 208 children (52.5%). Drug susceptibility results were available in 188 children: 9.6% (n = 18) were resistant to INH and 3.1% (n = 6) were MDR. INH resistance was more common in immigrants compared with native families (11.9% vs. 0%; P = 0.013), as was also MDR (4.5% vs. 0%; P = 0.34). Extrapulmonary TB and previous antituberculous treatment were significantly associated with INH and MDR, while immunosuppression was associated only with MDR.

Conclusions: The rates of INH and MDR TB were different according to the parents’ origin, with higher rates among children born to foreign parents. Local surveillance of drug-resistant TB is critical to develop appropriate guidelines for treatment.

Supplemental Digital Content is available in the text.

From the *Paediatric Infectious Diseases Unit, Gregorio Marañón Hospital; Molecular ImmunoBiology Laboratory, Health Reseach Institute Gregorio Marañón (IiSGM), Madrid, Spain; Paediatric Infectious Diseases Unit, La Paz Hospital, Madrid, Spain; §Division of Paediatric Infectious Diseases, Center for Vaccines and Immunity, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, OH; Immunodeficiency Unit, 12 de Octubre University Hospital; Mycobacterial Laboratory, National Centre of Microbiology and **Paediatrics Department, Carlos III Hospital, Madrid, Spain.

Accepted for publication October 2, 2013.

The EREMITA Study Group is provided in the Appendix.

The authors have no funding or conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (

Address for correspondence: Begoña Santiago, MD, Molecular ImmunoBiology Laboratory, Health Reseach Institute Gregorio Marañón (IiSGM), c/ Dr. Esquerdo, 46, 28007, Madrid, Spain. E-mail:

© 2014 by Lippincott Williams & Wilkins, Inc.