82098a6d1f96df628fdb25ed6e1c7767 337137.pdf c3b9d95ef861e59d7e7d28bb85c49267c0199f5d 337137.pdf 12e68659ad5d8fa7da27f5f7537ef88fa4c13ca4e81f83cd70b0f074d6ff13e2 337137.pdf Title: Trends in Antituberculosis Drug Resistance and Associated Factors: A 31-Year Observational Study at a Tertiary Hospital in Barcelona Subject: Objective: To analyze trends in resistance to antituberculous drugs over a 31-year period (1991–2022) at a hospital in Barcelona and to identify associated epidemiological determinants. Methods: This study included culture-confirmed tuberculosis cases diagnosed between 1991 and 2022. Drug susceptibility testing was conducted with clinical data from hospital records and epidemiological data from the Barcelona Public Health Agency. The primary outcome was resistance to first-line drugs. A subset of isolates was tested for second-line drugs. Trends were compared between the periods 1991–2000 and 2001–2022, aligning with increased immigration. Factors associated with resistance were examined using multivariate regression analysis. Results: Among the 2448 patients included, tuberculosis cases peaked in the 1990s and subsequently declined, while drug resistance increased. Overall, 12.2% of isolates showed resistance to at least one drug: 8.5% were monoresistant, 2.3% multiresistant, and 1.4% polyresistant. The 2001–2022 period had a higher resistance rate (OR 1.63; 95%CI 1.28–2.09) but lower multiresistance (OR 0.40; 95%CI 0.23–0.69). Resistance among new cases doubled from 6.4% to 12.8%, while rates among previously treated cases remained stable. The predictors of resistance were foreign-born (OR 1.52; 95%CI 1.21–1.91) and previous tuberculosis treatment (OR 2.88; 95%CI 2.17–3.81). A total of 90% of isolates remained susceptible to fluoroquinolones and aminoglycosides. Conclusions: Although tuberculosis incidence has declined over the past three decades, antibiotic resistance has increased, driven by foreign-born and retreatment cases. Ongoing drug susceptibility testing, access to second-line therapies, and targeted public health interventions for high-risk populations are essential to maintain control in low-incidence settings. Keywords: tuberculosis; drug-resistance; surveillance; immigration; public-health Author: Mateu Espasa, Belén Pagán, Mariana Fernández-Pittol, Ángels Orcau, Griselda Tudó, Felipe García, Jose-Antonio Martínez, Néstor Soler, Laura Horvath-Ruiz, Lorena San-Nicolás, Diego Martínez, Climent Casals-Pascual, Jordi Vila, Juan-Pau Millet, Joan A. Caylà and Julian Gonzalez-Martin Creator: LaTeX with hyperref Producer: pdfTeX-1.40.29; modified using OpenPDF 1.4.2 CreationDate: Tue Sep 22 13:11:27 2026 CEST ModDate: Sun Sep 27 12:24:54 2026 CEST Custom Metadata: yes Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 15 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 1120650 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- WNWTFR+VnURWPalladioL-Bold Type 1 Custom yes yes yes 88 0 BPNQAF+URWPalladioL-Bold Type 1 Custom yes yes yes 89 0 ILXGXV+VnURWPalladioL Type 1 Custom yes yes yes 90 0 JFSNKL+URWPalladioL-Roma Type 1 Custom yes yes yes 91 0 PINGSA+URWPalladioL-Ital Type 1 Custom yes yes yes 92 0 FXXUVH+CMSY10 Type 1 Builtin yes yes yes 151 0 FPLDLL+PalatinoLinotype,Italic CID TrueType Identity-H yes yes yes 142 0 FPNNQK+PalatinoLinotype CID TrueType Identity-H yes yes yes 143 0 FPLDLL+PalatinoLinotype,Bold CID TrueType Identity-H yes yes yes 144 0 WBVKDJ+URWPalladioL-BoldItal Type 1 Custom yes yes yes 188 0 FPLDLL+PalatinoLinotype,Italic CID TrueType Identity-H yes yes yes 181 0 FPNNQK+PalatinoLinotype CID TrueType Identity-H yes yes yes 182 0 FPLDLL+PalatinoLinotype,Bold CID TrueType Identity-H yes yes yes 183 0 FPLDLL+PalatinoLinotype,Italic CID TrueType Identity-H yes yes yes 221 0 FPNNQK+PalatinoLinotype CID TrueType Identity-H yes yes yes 222 0 FPLDLL+PalatinoLinotype,Bold CID TrueType Identity-H yes yes yes 223 0 OVNEXW+EURM10 Type 1 Builtin yes yes yes 336 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2026-10-28 03:57:41 CET RepresentationInformation: 337137.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2026-10-27 18:07:36 CET Size: 1120650 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 415 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: ViewerPreferences: HideToolbar: false HideMenubar: false HideWindowUI: false FitWindow: true CenterWindow: false DisplayDocTitle: false NonFullScreenPageMode: UseNone Direction: L2R ViewArea: CropBox ViewClip: CropBox PrintArea: CropBox PageClip: CropBox PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Item: Title: Results Children: Item: Title: Global TB Cases Distribution by Period Item: Title: TB Cases Demographic Data Item: Title: 1st Line TB Drug Resistance Data Item: Title: 2nd Line TB Drug Resistance Data Item: Title: Discussion Item: Title: Materials and Methods Item: Title: Conclusions Item: Title: References Info: Title: Trends in Antituberculosis Drug Resistance and Associated Factors: A 31-Year Observational Study at a Tertiary Hospital in Barcelona Author: Mateu Espasa, Belén Pagán, Mariana Fernández-Pittol, Ángels Orcau, Griselda Tudó, Felipe García, Jose-Antonio Martínez, Néstor Soler, Laura Horvath-Ruiz, Lorena San-Nicolás, Diego Martínez, Climent Casals-Pascual, Jordi Vila, Juan-Pau Millet, Joan A. Caylà and Julian Gonzalez-Martin Subject: Objective: To analyze trends in resistance to antituberculous drugs over a 31-year period (1991–2022) at a hospital in Barcelona and to identify associated epidemiological determinants. Methods: This study included culture-confirmed tuberculosis cases diagnosed between 1991 and 2022. Drug susceptibility testing was conducted with clinical data from hospital records and epidemiological data from the Barcelona Public Health Agency. The primary outcome was resistance to first-line drugs. A subset of isolates was tested for second-line drugs. Trends were compared between the periods 1991–2000 and 2001–2022, aligning with increased immigration. Factors associated with resistance were examined using multivariate regression analysis. Results: Among the 2448 patients included, tuberculosis cases peaked in the 1990s and subsequently declined, while drug resistance increased. Overall, 12.2% of isolates showed resistance to at least one drug: 8.5% were monoresistant, 2.3% multiresistant, and 1.4% polyresistant. The 2001–2022 period had a higher resistance rate (OR 1.63; 95%CI 1.28–2.09) but lower multiresistance (OR 0.40; 95%CI 0.23–0.69). Resistance among new cases doubled from 6.4% to 12.8%, while rates among previously treated cases remained stable. The predictors of resistance were foreign-born (OR 1.52; 95%CI 1.21–1.91) and previous tuberculosis treatment (OR 2.88; 95%CI 2.17–3.81). A total of 90% of isolates remained susceptible to fluoroquinolones and aminoglycosides. Conclusions: Although tuberculosis incidence has declined over the past three decades, antibiotic resistance has increased, driven by foreign-born and retreatment cases. Ongoing drug susceptibility testing, access to second-line therapies, and targeted public health interventions for high-risk populations are essential to maintain control in low-incidence settings. 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