Delay in diagnosing multidrug-resistant tuberculosis (MDR-pTB) in children prolongs time to effective treatment. Data on risk factors for pediatric MDR from low-incidence countries are scarce. Retrospective nationwide case–control study to analyze MDR-pTB cases in Germany between 2010 and 2020 in comparison to a drug-susceptible (DS) -pTB group. We included 52 MDR cases (24 tuberculosis (TB), 28 TB infection (TBI) ; mean age 7. 3 years) and 56 DS cases (31 TB, 26 TBI; mean age 7. 9 years). Groups were similar for sex, household size, and migration background. Compared to the DS group, more children with MDR were born in the Commonwealth of Independent States (CIS) (22% MDR-pTB vs. 13% DS-pTB, n. s. ) and had more MDR index cases (94% MDR-pTB, 5% DS-pTB, \ (p\) < 0. 001). The interval between first healthcare contact and initiation of effective therapy was significantly longer in MDR-pTB (47 days) than in DS-pTB (11 days, \ (p\) < 0. 001), correlating with disease progression. Treatment for MDR-pTB was successful in 74%, but 22% experienced long-term adverse effects (e. g. , hepatopathy, hearing loss). \ (Conclusions\): Close contact to MDR cases or birth in MDR-TB-high-incidence countries are risk factors for MDR-pTB. Early identification of potential MDR index cases by contact investigation, and susceptibility testing in children from high-burden MDR-TB countries are essential for timely diagnosis and treatment, reducing the severity of disease and treatment side effects.
Schäfer et al. (Thu,) studied this question.