Pulmonary resection for multidrug-resistant tuberculosis: the Israeli experience (1998-2011).

keY words: Treatment with the second-line drugs is less effective and more toxic than the first-line drugs and patients require a longer period of treatment (18–24 months compared to the standard 6–9 months) [1]. MDR-TB1 may be newly acquired (primary MDR-TB) by contracting the infection from a patient already infected with the resistant strain, or it may evolve in a patient with a sensitive strain who was inadequately treated (secondary MDR-TB). Extensively drug-resistant tuberculosis, a subgroup of MDR-TB, now recognized to exist around the world, is defined as the resistance of M. tuberculosis to the most important second-line drugs (any one of the fluoroquinolones and at least one of the second-line injectable drugs) in addition to isoniazid and rifampicin and is more likely to be associated with the worst outcome. The estimated worldwide incidence of MDR-TB in 2010 was 650,000 with a prevalence of about 12 million cases of which 10% were XDR-TB2 [2-5]. The highest rate is found in Asia (56%) and Eastern Europe (20%). Medical treatment is usually not satisfactory, with an estimated mortality rate of 26%. Therefore, the option of pulmonary resection to remove a destroyed lung, lobe or segment may be offered to annihilate a great number of TB organisms that do not respond to chemotherapy. According to the recent literature, the outcome of patients with MDR-TB improved following pulmonary resections and the postoperative complication rate was low (5%–26%) [6-9]. Israel, a country of immigrants, has experienced mass immigration from countries highly endemic for tuberculosis, such as the Former Soviet Union and Ethiopia. About one million immigrants were absorbed in the 1990s and the incidence of new tuberculosis cases, especially MDR-TB strains, significantly increased. A recent study analyzed the outcome of MDR-TB in Israel [10] and found a relatively high mortality rate (30%). Poor prognosis factors were related to older age, hypoalbuminemia, alcohol consumption, high infectiousness, and XDR-TB. The aim of the present study was to report our surgical experience in the management of these patients. MDR-TB = multidrug-resistant tuberculosis XDR-TB = extensively drug-resistant tuberculosis m ultidrug-resistant tuberculosis, defined as the resistance of Mycobacterium tuberculosis to at least the two most powerful first-line anti-tuberculosis drugs, isoniazid and rifampicin, is a major challenge for health care authorities.