Eurosurveillance - Volume 7, Issue 6, 01 June 2002

Antimicrobial resistance represents a critical problem in human medicine today, from both clinical and economic points of view. In 1999, the Council of the European Union included antibiotic resistance among the public health priorities in the Community, and a resolution entitled 'A strategy against the microbial threat' was issued (1). According to this document, the establishment or strengthening of a surveillance system for the collection of reliable and comparable data on a national and international scale is one of the main interventions needed to control and prevent antibiotic resistance. Surveillance systems should also integrate data about the use and prescription of antibiotics (2).

With the exception of Israel, representative data from Western and Central Europe indicate consistently low levels of resistance to isoniazid (0-9,3%) or rifampicin (0-2,1%) and of multidrug resistance (0-2,1%) among new tuberculosis (TB) cases. Resistance is more frequent among previously treated cases, but comparisons of data should be done cautiously, as criteria for inclusion in TB notifications may vary across countries. In Western Europe, drug resistance is more frequent among cases of foreign origin, a group with high TB incidence. In 1999, cases of foreign origin accounted for over 90% of the MDR cases in the West, and for all MDR cases notified in Israel. The majority of foreign born cases notified originated from Africa or Asia. In the East, representative data from the Baltic States show that overall, 15% of TB cases notified in 1999 were MDR, among the highest proportion worldwide and indicating inadequacies in previous treatment programmes. In the other countries of the former Soviet Union, non-representative data show high levels of resistance which, along with data from the Baltic states and results of surveys, are very alarming.