Tuberculosis: Drug resistance in Canada 2014

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Organization: Public Health Agency of Canada

Date published: 2015-12-17

Related Topics

Acknowledgements

The Surveillance and Epidemiology Division at the Public Health Agency of Canada would like to acknowledge the members of the Canadian Tuberculosis Laboratory Technical Network and their teams as well as, colleagues at the National Microbiology Laboratory for their contribution to and participation in the Canadian Tuberculosis Laboratory Surveillance System.

Table of contents:

List of figures

List of tables

List of appendices

Acronyms and abbreviations

Alta.
Alberta
AK 
Amikacin
B.C.
British Columbia
BCG
Bacillus Calmette-Guérin
CI
Confidence interval
CLSI
Clinical and Laboratory Standards Institute
CM
Capreomycin
CPHLN
Canadian Public Health Laboratory Network
CTBLSS 
Canadian Tuberculosis Laboratory Surveillance System
CTLTN
Canadian Tuberculosis Laboratory Technical Network
EMB
Ethambutol
ETH
Ethionamide
INH
Isoniazid
KM
Kanamycin
LIN
Linezolid
M. africanum
Mycobacterium africanum
M. bovis
Mycobacterium bovis
M. canetti
Mycobacterium canetti
M. caprae
Mycobacterium caprae
M. microti
Mycobacterium microti
M. pinnipedii
Mycobacterium pinnipedii
M. tuberculosis 
Mycobacterium tuberculosis
Man. 
Manitoba
MDR-TB
Multidrug-resistant tuberculosis
MOX 
Moxifloxacin
MTBC
Mycobacterium tuberculosis complex
N.B.
New Brunswick
N.L.
Newfoundland and Labrador
NRCM
National Reference Centre for Mycobacteriology
N.S.
Nova Scotia
Nvt.
Nunavut
N.W.T.
Northwest Territories
OFL
Ofloxacin
Ont.
Ontario
PAS
Para-aminosalicylic acid
PHAC 
Public Health Agency of Canada
P.E.I.
Prince Edward Island
ProvLab
Provincial Laboratory of Public Health (Alberta)
PZA
Pyrazinamide
Que.
Quebec
RBT
Rifabutin
RMP
Rifampin
Sask.
Saskatchewan
SM
Streptomycin
TB
Tuberculosis
XDR-TB
Extensively drug-resistant tuberculosis
Y.T.
Yukon

Introduction

Drug-resistant strains of tuberculosis (TB) pose a serious threat to Canadian TB prevention and control efforts. Although drug-resistant TB has not yet been identified as a major problem in Canada, it is a potential issue both because Canadians frequently travel abroad and because many individuals migrate to Canada from countries with high TB rates and associated drug resistance.

The Canadian Tuberculosis Laboratory Surveillance System (CTBLSS) was created in 1998 as part of Canada's response to a growing worldwide concern about TB drug resistance. It was established by Health Canada's Division of Tuberculosis Prevention and Control in the Bureau of HIV/AIDS, STD and TB at the Laboratory Centre for Disease Control in collaboration with the Canadian Tuberculosis Laboratory Technical Network (CTLTN) and participating laboratories. The CTBLSS was designed to monitor emerging trends and patterns in anti-tuberculosis drug resistance in Canada and is currently managed by the Public Health Agency of Canada (PHAC).

This report is part of an annual surveillance report series that describes data collected through the CTBLSS. Specifically, this report provides details on the overall level of TB drug resistance in Canada for the period 2004 to 2014, with a focus on 2014.

The data presented in this report is intended to inform public health action as well as policy and program development and assessment.

Background

Patterns of drug resistance

TB drug resistance is determined through susceptibility testing of clinical specimens obtained from individuals with culture-positive TB.Footnote 1 People with TB are said to have drug-resistant TB if the strain of Mycobacterium tuberculosis causing their disease is resistant to one or more of the four first-line drugs, isoniazid, rifampin, pyrazinamide or ethambutol. The following resistance patterns are described in this report:

  • Monoresistance – defined as resistance to one first-line anti-TB drug only (isoniazid, rifampin, ethambutol or pyrazinamide).
  • Polyresistance (other patterns) – defined as resistance to more than one first-line anti-TB drug, not including the isoniazid and rifampin combination.
  • Multidrug-resistant tuberculosis (MDR-TB) – defined as resistance to isoniazid and rifampin with or without resistance to other anti-tuberculosis drugs.
  • Extensively drug-resistant TB (XDR-TB) – defined as resistance to isoniazid and rifampin and any fluoroquinolone and at least one of the three injectable second-line drugs (amikacin, capreomycin or kanamycin).Footnote 2

TB drug resistance standards and testing in Canada

The mission of the CTLTN is to promote excellence, standardization and quality assurance in mycobacteriology services. The CTLTN is a pan-Canadian network of technical and scientific heads of provincial and territorial TB laboratories (Appendix I).

 The goals of the CTLTN are to:

  • standardize laboratory methodologies;
  • improve biosafety operational practices and physical requirements;
  • implement biosafety guidelines;
  • participate in national surveillance and proficiency programs; and
  • exchange services and information about new technologies.

Laboratory testing methods in Canada, including drug selection and the critical concentrations used for routine drug susceptibility testing, are in line with recommended laboratory standards.Footnote i, Footnote 3, Footnote 4 Participating CTLTN laboratories perform routine susceptibility testing of Mycobacterium tuberculosis or Mycobacterium tuberculosis complex (MTBC) isolates against first-line anti-tuberculosis drugs using fluorometric proportion method BACTEC® MGIT 960. Table 1 provides a list of recommended first-line and second-line anti-tuberculosis drugs and the recommended critical concentrations to be used for testing.Footnote 3, Footnote 4

Second-line drug susceptibility testing varies across jurisdictions. Typically, isolates are tested for resistance to amikacin, kanamycin, capreomycin, ethionamide, linezolid, ofloxacin, moxifloxacin, para-aminosalicylic acid and rifabutin.

Methods

Overview of the Canadian Tuberculosis Laboratory Surveillance System

The CTBLSS is an isolate-based surveillance system designed to collect data on TB drug resistance across Canada. Drug susceptibility test results of all unique isolates tested in the previous calendar year are voluntarily submitted annually to PHAC by provincial TB laboratories for inclusion in the CTBLSS. Participating laboratories are members of the CTLTN (representing all provinces and territories).

Data for the CTBLSS are collected either through the manual completion of a standard reporting form (Appendix II) or electronically. Standardized data recoding procedures are applied to all data to create a national dataset. The following information is submitted to PHAC:

  • the date the isolate or specimen was received at the laboratory;
  • the specimen identification number provided by the laboratory;
  • the province/territory where the isolate was tested;
  • the province/territory from which the isolate originated;
  • the sex of the individual from whom the isolate originated;
  • the date of birth or age at time of testing of the individual from whom the isolate originated; and
  • drug susceptibility results (drug tested, including concentration of the drug tested).

Data are submitted for confirmed cases of MTBC demonstrated on culture, including M. tuberculosis, M. africanum, M. canetti, M. caprae, M. microti, M. pinnipedii or M. bovis. Results may be submitted at the species level or for MTBC only without species identification. Some laboratories also submit results for the M. bovis BCG strain, a complication of TB vaccination often found in immunocompromised patients. These results are excluded from this report because this strain is not infectious.

All participating laboratories test for resistance to the first-line antibiotics isoniazid, ethambutol, and rifampin. Although the Canadian Tuberculosis Standards (7th edition) recommends that laboratories perform drug susceptibility testing to pyrazinamideFootnote 1, British Columbia does not routinely test for resistance to this drug. If resistance to any first-line drug is detected, British Columbia will subsequently test the isolate for resistance to pyrazinamide.

Results of second-line drug susceptibility testing are submitted for isolates showing resistance to isoniazid and rifampin. To rule out XDR-TB, laboratories are asked to report results for at least one of the fluoroquinolones (ofloxacin, moxifloxacin or levofloxacin) and at least one of the injectable agents (amikacin, kanamycin and capreomycin).

Not all provinces and territories have the capacity to perform drug susceptibility testing. Those without this capacity prepare the isolates and forward them to other provincial laboratories for testing. In some instances, the laboratory that tests the sample submits the results to PHAC on behalf of the originating province or territory.

The British Columbia Public Health Microbiology and Reference Laboratory at the British Columbia Centre for Disease Control tests and reports first-line susceptibility results for British Columbia and Yukon. The Provincial Laboratory of Public Health (ProvLab) in Alberta tests and reports isolates for Alberta and Northwest Territories, and the Central Public Health Laboratory in Ontario tests and reports results for Ontario and Nunavut. The National Reference Centre for Mycobacteriology (NRCM)Footnote ii located in Manitoba conducts first-line susceptibility testing for Newfoundland and Labrador, Manitoba, New Brunswick, Nova Scotia and Prince Edward Island. In this case, the NRCM returns test results to the originating province and the originating province submits their results to PHAC. All remaining provinces conduct their own first-line testing and do not routinely report results for any other jurisdiction.

Four laboratories in Canada conduct second-line drug susceptibility testing: the ProvLab in Alberta, the Central Public Health Laboratory in Ontario, the Laboratoire de santé publique du Québec and the NRCM. The NRCM tests the susceptibility of isolates to second-line drugs for all provinces and territories that do not conduct such testing at their laboratories. Upon request, the NRCM also tests isolates submitted by any provincial laboratory to confirm resistance patterns. Results from testing done by NRCM are returned to the provincial laboratory that submitted the isolates for testing and  the provincial laboratory then submits these results to PHAC.

Tabulation and presentation of results

This report provides an overview of TB drug resistance in Canada for the period 2004 to 2014. Select data are presented by province/territory and by age and sex where feasible. Data from 2014 (the most recent reporting year for which data are available) are highlighted as well as important trends over time.

The data presented in this report were extracted from the CTBLSS database on March 30, 2015 and have been validated by the reporting laboratory. Results from cultures that grow in a given year are included in the statistics for that calendar year, otherwise the results are reflected in the subsequent year's report. For example, if a specimen was received by the laboratory on December 20, 2014 and the culture did not grow M. tuberculosis until January 2015, these results would be reflected in the 2015 report.

Samples submitted to the laboratory for drug susceptibility testing may be obtained at the time of the individual's diagnosis or at any time during treatment. Depending on the treatment duration, an individual may be tested multiple times over several years. The number of isolates described in this report, therefore, is not equal to the number of culture-positive cases reported through the case-based surveillance system over the same time period. That is because an individual with culture-positive TB is only reported once in the year of diagnosis but may be tested repeatedly for drug resistance over the course of several years until cured or until the prescribed treatment is completed. In the event that two specimens are confirmed to be from the same individual in a given calendar year, only the most recent susceptibility result is retained.

No statistical procedures were used for comparative analyses in this report, nor were any statistical techniques applied to account for missing data. Data in tables with small cell sizes (n ≤ 5) were not suppressed, since disclosure is not deemed to pose any risk of identifying individuals. These procedures are consistent with PHAC's Directive for the collection, use and dissemination of information relating to public health.Footnote 5

Results

In 2014, anti-tuberculosis drug susceptibility test results for 1,393 isolates were reported to PHAC. Of these, 790 (56.7%) were reported as MTBC where the species was known (786 were M. tuberculosis, two were M. africanum and two were M. bovis) and 586 (42.1%) were MTBC of an unknown species. Seventeen (1.2%) isolates were identified as M. bovis BCG (13 originating from Ontario, three from Alberta and one from Manitoba) and were excluded from further analyses (data not shown). Laboratory results for 1,376 MTBC isolates were analyzed for this report. Table 2 provides a breakdown of the number of isolates by reporting and originating province or territory. Figure 1 shows the number of MTBC isolates tested by the province or territory of origin.

Figure 1: Number of Mycobacterium tuberculosis complex isolates tested by province or territory of origin, 2014

Figure 1
Figure 1 - Description

The bar chart shows the breakdown of the total number of isolates tested by the province or territory of origin. The horizontal axis names the provinces and territories. The vertical axis shows the number of isolates from 0 to 500 in increments of 50.

In descending order, the number of isolates tested by originating province or territory for 2014 was as follows:

Figure 1: Number of Mycobacterium tuberculosis complex isolates tested by province or territory of origin, 2014.
Province or territory of origin Number of reported isolates
Ontario 457
British Columbia 270
Quebec 186
Alberta 181
Manitoba 125
Nunavut 66
Saskatchewan 63
Nova Scotia 8
Newfoundland and Labrador 6
New Brunswick 6
Yukon 4
Prince Edward Island 2
Northwest Territories 2

For the period 2004 to 2014, drug susceptibility test results were reported for 14,813 isolates (Table 3). Of the results received between 2004 and 2014, 1,382 (9.3%) were resistant to one or more of the first-line medications, 168 isolates (1.1%) were identified as multidrug-resistant and seven (< 0.1%) were identified as extensively drug-resistant (Table 3).

Any first-line drug resistance

In 2014, all 1,376 MTBC isolates were tested for resistance to isoniazid, rifampin and ethambutol and 1,143 (83%) were tested for resistance to pyrazinamide (Table 4). One hundred and seven (7.8%) of the isolates tested were resistant to isoniazid, 30 (2.6%) were resistant to pyrazinamide, 24 (1.7%) were resistant to rifampin and six (0.4%) were resistant to ethambutol (Figure 2).

Figure 2: Percentage of isolates tested with any resistance to isoniazid, pyrazinamide, rifampin and ethambutol 2014.

Figure 2
Figure 2 - Description

The bar chart shows the percentage of the total number of isolates tested with resistance to each of the four first-line drugs. The horizontal axis lists the drugs tested; from left to right, isoniazid (INH), pyrazinamide (PZA), rifampin (RMP), and ethambutol (EMB). The vertical axis shows the drug resistance percentage ranging from 0 to 9% in increments of 1%.

Percentage of isolates tested with any resistance to isoniazid, pyrazinamide, rifampin and ethambutol, 2014.
Resistance pattern Drug resistance (%)
Any resistance to isoniazid 7.8%
Any resistance to pyrazinamide 2.6%
Any resistance to rifampin 1.7%
Any resistance to ethambutol 0.4%

Figure 3 shows the changes over time in the percentage of isolates resistant to each of the first-line drugs for the period 2004 to 2014. There has been very little change in the percentage of tested isolates showing any resistance. For the period 2004 to 2014, 7.9% (range: 6.7% to 9.2%) of all isolates tested were resistant to isoniazid (Table 4). Ethambutol, rifampin and pyrazinamide resistance have remained below 3%.

Figure 3: Percentage of isolates tested with any resistance to isoniazid, pyrazinamide, rifampin and ethambutol, 2004 to 2014

Figure 3
Figure 3 - Description

The line graph shows the percentage of isolates with resistance to each of the four first-line anti-tuberculosis drugs from 2004 to 2014. Each line represents one of the four drugs. The horizontal axis displays the reporting year from 2004 to 2014. The vertical axis shows the drug resistance percentage from 0 to 10% in increments of 1%.

The percentage of isolates tested with any resistance to isoniazid, rifampin, ethambutol, and pyrazinamide for 2004 to 2014 are as follows:

Figure 3: Percentage of isolates tested with any resistance to isoniazid, pyrazinamide, rifampin and ethambutol, 2004 to 2014.
Drug resistance (%) Reporting year
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Any resistance to isoniazid 7.4% 8.2% 7.3% 8.7% 7.5% 8.5% 7.9% 9.2% 7.9% 6.7% 7.8%
Any resistance to rifampin 1.0% 1.8% 1.7% 1.0% 1.4% 1.6% 1.4% 1.6% 0.7% 1.2% 1.7%
Any resistance to ethambutol 0.8% 1.5% 0.9% 1.8% 1.0% 1.3% 0.8% 0.7% 0.3% 0.7% 0.4%
Any resistance to pyrazinamide 2.4% 2.1% 1.5% 2.7% 2.1% 1.7% 2.4% 2.6% 2.8% 2.2% 2.6%

Monoresistance

Overall, in 2014, 131 TB isolates (9.5% of all isolates tested) were reported to be resistant to at least one of the four first-line drugs (Table 4). The majority 108, (82.4%) were monoresistant.  Of these 84 (77.8%) were isoniazid monoresistant, 19 (17.6%) were pyrazinamide monoresistant and five (4.6%) were rifampin monoresistant. No isolates were identified as ethambutol monoresistant (Table 5 to Table 17). For the period 2004 to 2014, 7.7% of all isolates tested were monoresistant, ranging from a high of 9.0% in 2011 to a low of 6.7% in 2013 (Table 4).

For the period 2004 to 2014, 28 isolates (0.2% of all isolates tested) were identified as rifampin-monoresistant. Of these, 15 (53.6%) originated from British Columbia; six (21.4%) from Ontario, two (7.1%) each from Alberta and Quebec, and one (3.6%) each from Saskatchewan, Northwest Territories and Nunavut. With the exception of 2004 and 2010 in which there were no reports of rifampin-monoresistant isolates, one to three rifampin-monoresistant isolates were reported each year from 2005 to 2014. In 2006, eight (0.6%) rifampin-monoresistant isolates were reported, representing an atypically high number for a one-year period (Table 5 to Table 17).

Polyresistance, multidrug-resistant and extensively drug-resistant TB

In 2014, four isolates (0.3%) were resistant to two or more of the first-line drugs excluding the isoniazid and rifampin combination (Table 4). All four were resistant to both isoniazid and pyrazinamide and susceptible to rifampin and ethambutol. Between 2004 and 2014 there were 64 (0.4%) isolates identified as polyresistant. Of these, 29 (45.3%) were resistant to isoniazid and ethambutol and 26 (40.6 %) were resistant to isoniazid and pyrazinamide. Of the remaining nine isolates, six were resistant to isoniazid, ethambutol, and pyrazinamide, two were resistant to rifampin and pyrazinamide, and one was resistant to ethambutol and pyrazinamide (Table 5 to Table 17).

In 2014, 19 (1.4%) of all isolates tested were resistant to both isoniazid and rifampin (identifying them as at least MDR-TB). Of these 19 isolates, ten (52.6%) were resistant only to isoniazid and rifampin, three (15.8%) were also resistant to ethambutol, two (10.5%) were also resistant to pyrazinamide and four (21.0%) were also resistant to pyrazinamide and ethambutol (Table 18).

To rule out XDR-TB, all 19 isolates found to be resistant to both isoniazid and rifampin were subsequently tested for resistance to select second-line drugs. Of these, 16 (84.2%) isolates were susceptible to both the injectable agents and the fluoroquinolones, one (5.2%) was resistant to an injectable agent but susceptible to the fluoroquinolones and one (5.2%) was resistant to a fluoroquinolone but susceptible to the injectable agents (data not shown). The remaining isolate was resistant to at least one of the injectable agents and to a fluoroquinolone. Therefore, in 2014, 18 isolates were identified as MDR-TB and one was identified as XDR-TB. Figure 4 presents patterns of TB drug resistance as a percentage of all isolates tested in 2014.

Figure 4: Tuberculosis drug resistance patterns as a percentage of isolates tested, 2014

Figure 4

* Multidrug-resistant TB is TB that is resistant to isoniazid and rifampin but does not meet the definition of extensively drug-resistant TB.
† Extensively drug-resistant TB is TB that is resistant isoniazid and rifampin, any fluoroquinolone and at least one of three injectable second-line drugs (amikacin, capreomycin and kanamycin).

Figure 4 - Description

The bar graph shows the percentage of the total number of isolates tested in 2014 that were drug resistant by type of resistance. The horizontal axis shows the resistance pattern including isolates that are monoresistant, isolates that are multidrug-resistant, polyresistant and extensively drug-resistant. The vertical axis displays the drug resistance percentage ranging for 0 to 9% in increments of 1%. 

The drug resistance patterns as a percentage of isolates tested in 2014 are as follows:

Figure 4. Tuberculosis drug resistance patterns as a percentage of isolates tested, 2014.
Resistance pattern Drug resistance (%)
Monoresistant 7.8%
Multidrug-resistant 1.3%
Polyresistant 0.3%
Extensively drug-resistant 0.1%

Note that multidrug-resistant TB is TB that is resistant to at least isoniazid and rifampin, but does not meet the definition of extensively drug-resistant TB. Extensively drug-resistant TB is TB that is resistant isoniazid and rifampin, any fluoroquinolone and at least one of three injectable second–line drugs (amikacin, capreomycin and kanamycin).

For the period 2004 to 2014, 168 isolates were classified as MDR-TB, representing 1.1% of isolates tested over this time (Table 4). Seven isolates were classified as XDR-TB, representing an annual average of less than 0.1% of the total number of isolates tested for this period. An average of 15 MDR-TB isolates were reported each year, ranging from a low of eight in 2012 (0.6% of all isolates) to a high of 22 in 2005 (1.6% of all isolates tested).

Figure 5 shows the overall pattern of reported TB drug resistance as a percentage of isolates tested for the period 2004 to 2014. While there were small fluctuations in the percentage of isolates showing various resistance patterns, there was no notable trend over time.

Figure 5: Tuberculosis drug resistance patterns as a percentage of isolates tested, 2004 to 2014

Figure 5

* Multidrug-resistant TB is TB that is resistant to isoniazid and rifampin but does not meet the definition of extensively drug-resistant TB.
† Extensively drug-resistant TB is TB that is resistant isoniazid and rifampin, any fluoroquinolone and at least one of three injectable second-line drugs (amikacin, capreomycin and kanamycin).

Figure 5 - Description

The line graph shows the percentage of isolates showing resistance based on the pattern of resistance to anti-TB medication from 2004 to 2014. The type of resistance presented includes isolates that are monoresistant, isolates that are multidrug-resistant, isolates that are extensively drug-resistant, and other patterns.

The tuberculosis drug resistance patterns as a percentage of isolates tested from 2004 to 2014 are as follows:

FIGURE 5: Tuberculosis drug resistance patterns as a percentage of isolates tested, Canada, 2004 to 2014.
Resistance pattern Reporting year
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Monoresistance 6.8% 7.7% 7.7% 8.8% 6.9% 7.4% 6.9% 9.0% 9.1% 6.7% 7.8%
Multidrug-resistant TB 0.9% 1.6% 1.1% 0.9% 1.1% 1.4% 1.3% 1.4% 0.6% 1.0% 1.3%
Polyresistant 0.9% 0.2% 0.2% 90.0% 40.0% 0.8% 0.5% 0.1% 0.1% 0.3% 0.3%
Extensively drug-resistant TB 0.0% 0.0% 0.1% 0.0% 0.1% 0.0% 0.1% 0.1% 0.1% 0.1% 0.1%

Note that multidrug-resistant TB is TB that is resistant to at least isoniazid and rifampin, but does not meet the definition of extensively drug-resistant TB. Extensively drug-resistant TB is TB that is resistant isoniazid and rifampin, any fluoroquinolone and at least one of three injectable second–line drugs (amikacin, capreomycin and kanamycin).

Geographical distribution

Overall, the total number of isolates tested and reported in 2014 (1,376) was similar to the number reported in 2013 (1,381) (Table 2). In 2014, the majority of reported isolates originated from five provinces: Ontario (33.2%), British Columbia (19.6%), Quebec (13.5%), Alberta (13.2%), and Manitoba (9.1%). Saskatchewan accounted for fewer than 5% of reported isolates while the territories (Northwest Territories, Nunavut and Yukon) and the Atlantic provinces (New Brunswick, Newfoundland and Labrador, Nova Scotia and Prince Edward Island) together accounted for fewer than 7% of reported isolates in 2014.

All isolates from Northwest Territories, Nunavut, Yukon, New Brunswick, Newfoundland and Labrador, and Prince Edward Island were fully susceptible to all first-line drugs tested. Of the 19 isolates resistant to both isoniazid and rifampin in 2014, four originated from Alberta, six from British Columbia, seven from Ontario and two from Quebec (Table 18).

For the period 2004 to 2014, all 168 MDR-TB isolates originated from six provinces: Alberta, British Columbia, Manitoba, Ontario, Quebec and Saskatchewan (Table 19). Of the seven isolates identified as XDR-TB, five originated from Ontario, one from Manitoba and one from Quebec.

Tables 5 through 17 present results of routine drug susceptibility testing of MTBC isolates to anti-tuberculosis drugs for the period 2004 to 2014, by province and territory.

Demographic information

In 2014, age or date of birth was reported for all but one of the 1,376 individuals from whom reported isolates were obtained (Table 20). Of the 131 isolates with drug resistance, 22.9% were from individuals 25 to 34 years of age and 20.6% were from individuals 35 to 44 years of age. 1.6% of isolates were from individuals under 15 years of age (Table 20). The XDR-TB isolate was from an individual 25 to 34 years of age.

In 2014, sex was known for individuals from whom 1,374 (99.9%) of the 1,376 isolates were obtained (Table 20). Males accounted for 56.6% of reported isolates in 2014 (Table 20). Of isolates with any resistance, females accounted for 51.9%, and one half were isolates with resistance to both isoniazid and rifampin. The XDR-TB isolate was from a female.

Discussion

In many parts of the world, drug resistance is a major challenge to preventing and controlling TB. Eastern Europe and Central Asia continue to have the world's highest proportion of MDR-TB cases.Footnote 6

Organisms resistant to both isoniazid and rifampin pose a considerable challenge to treatment and prevention efforts because effective anti-tuberculosis drugs are limited. Data published by the World Health Organization show that globally in 2012, about 3.6% (95% CI: 2.1% - 5.1%) of new TB cases and 20.2% (95% CI: 13.3% - 27.2%) of previously treated TB cases were MDR-TB.Footnote 6 Although the data captured through the CTBLSS do not distinguish between isolates from new versus previously treated cases of TB, the fact that only 1.3 % of isolates tested in 2014 were MDR-TB is a considerably lower finding than global estimates. In addition, the identification of seven XDR-TB cases over the period 2004 to 2014 indicates that XDR-TB in Canada is still a relatively rare event.

Overall, there was no notable change in the percentage of isolates with resistance to first-line medications in Canada from 2004 to 2014; however, geographic distribution changed. The percentage of isolates originating from Ontario decreased whereas the percentage originating from Alberta and British Columbia increased relative to the number of reports received in previous years. This may indicate a change in the overall distribution of TB disease in Canada, and requires further monitoring.

Strengths and limitations

The CTBLSS is the result of successful collaboration between federal, provincial and territorial governments and the CTLTN. The primary objective of the CTBLSS is to monitor emerging trends and patterns in anti-tuberculosis drug resistance in Canada. This report presents detailed data on the extent of first- and second-line TB drug resistance in Canada, disaggregated by province/territory and, where feasible, by sex and age. As the primary source of national data on TB drug resistance in Canada, the data within this report provide timely information for public health action, as well as policy and program development and assessment.

Prior to analysis and report preparation, all data were reviewed for errors, inconsistencies and completeness. Submitting laboratories were provided with a summary report of their data for review. Following validation by the reporting laboratories, the data were integrated into the CTBLSS database. Nevertheless, like most surveillance data, the data in this report are subject to possible coding, reporting and processing errors.

Previously published data are subject to updates resulting from late reporting or when revisions are received from participating laboratories. Any revisions to previously reported data are reflected in subsequent reports. Therefore, the data presented in this report are considered the most up-to-date and replace those previously published in this report series.

Although efforts are made to ensure that multiple records for any one individual in a given year are removed, given the minimal identifying information available for each isolate (age and sex), it is possible that multiple records from one individual may be included in the database. This bias is likely minimal given the validation process with the data providers.

Demographic and clinical data collected through the CTBLSS are limited. No data are collected on ethnic origin, diagnostic/clinical information, or treatment outcome. Additional demographic and clinical information on individuals from whom the TB isolates were obtained would facilitate a more in-depth epidemiological assessment of drug resistance patterns in Canada. Additionally, differentiation between primary and acquired drug resistance and differing resistance pattern among new cases in comparison to re-treatment cases is not possible based on data collected through this surveillance system. However, the Tuberculosis in Canada report, which provides an overview of the overall number of reported active TB cases and corresponding incidence rates in Canada by select demographic and clinical characteristics, presents case-based (vs. isolate-based) data on primary and acquired drug resistance in Canada that are not presented here. Together, these two reports provide a comprehensive overview of TB case and drug resistance surveillance data from a national perspective.

Typically, only isolates with MDR-TB or other extensive resistance patterns will undergo drug sensitivity testing to select second-line drugs. Although the Clinical and Laboratory Standards Institute (CLSI) recommends that isoniazid-monoresistant isolates, as well as other polyresistant, non-MDR isolates be tested for second-line drug resistance, this is not universally reported in Canada. Other isolates which are not MDR-TB may be resistant to fluoroquinolones because of the widespread use of these antibiotics for other respiratory infections. To some extent, this limits our understanding of the emergence of second-line drug resistance within Canada.

Conclusion

Data collected through the CTBLSS indicate that the presence of TB drug resistance in Canada is currently below the global average and has remained relatively stable since reporting began. However, the CTBLSS remains vital to the monitoring of TB drug resistance in Canada in order to respond to growing worldwide concern about resistance and the emergence of XDR-TB.

Appendices

Appendix I: Participating Laboratories of the Canadian Tuberculosis Laboratory Technical Network (CTLTN)

Alberta

Provincial Laboratory of Public Health

Calgary

Cary Shandro
Technologist Mycobacteriology

Dr. Greg Tyrrell
Clinical Microbiologist

Graham Tipples
Medical/Scientific Director

British Columbia

British Columbia Centre for Disease Control
Public Health Microbiology and Reference Laboratory

Vancouver

Dr. Mabel Rodrigues
Mycobacteriology/TB Laboratory, Section Head

Dr. Patrick Tang
Medical Microbiologist

Dr. Judy L. Isaac-Renton
Director, Laboratory Services

Manitoba

Diagnostics Services Manitoba
Health Sciences Centre

Winnipeg

Assunta Rendina
Charge Technologist, Mycobacteriology

Doug Swidinsky
Senior Technologist

New Brunswick

Department of Laboratory Medicine
Saint John Regional Hospital

Saint John

Hope MacKenzie
MLT3-Supervisor CL3 Lab

Dr. Duncan Webster
Medical Microbiologist/ Infectious Disease

Dr. Marek Godlewski
Laboratory Director

Newfoundland and Labrador
Newfoundland and Labrador Public Health Laboratory

St. John's

Audrey Martin
Tech II

Lourens Robberts
Director & Clinical Microbiologist

Northwest Territories

Stanton Territorial Hospital

Yellowknife

Sherrill Webber
Tech II, Microbiology

Carolyn Russell
Laboratory Supervisor

Cheryl Case
Manager
Therapeutic & Diagnostic Services

Nova Scotia

Department of Pathology & Laboratory Medicine
Queen Elizabeth II Health Sciences Centre

Halifax

Sherry Maston
Division of Medical Microbiology

Dr. David Haldane,
Director, Provincial Public Health Laboratory Network and Special Pathogens

Dr. Todd Hatchette
Director, Pathology and Laboratory Medicine

Nunavut

Qikiqtani General Hospital

Iqaluit

Sonia Marchand
Laboratory Health
Ontario

Central Public Health Laboratory
Ontario Agency for Health
Protection and Promotion

Toronto

Kevin May
Operational Lead, Mycobacteriology

Dr. Frances Jamieson
Medical Microbiologist -TB and Mycobacteriology

Alex Marchand-Austin
Manager, Laboratory Surveillance and Data Management

Quebec

Laboratoire de santé publique du Québec
Institut national de santé publique du Québec

Sainte-Anne-de-Bellevue

Hafid Soualhine
Head, Mycobacteriology & Aerobic Actinomycetes

Dr. Cécile Tremblay
Director

Saskatchewan

Saskatchewan Disease Control Laboratory

Regina

Rita Thomas
Technologist, TB/Bacteriology

Dr. Christine Turenne
Microbiologist

Dr. Paul Levett
Microbiologist

Dr. David Alexander
Microbiologist

Dr. Greg Horsman
Director, Saskatchewan Health
Federal

National Microbiology Laboratory
Public Health Agency of Canada

Winnipeg

Joyce Wolfe
Program Manager, Mycobacteriology

Appendix II: M. tuberculosis Complex Antimicrobial Susceptibility Reporting Form

Please note that form in this section are available in PDF format only. For downloading or viewing document is available
M. tuberculosis Complex Antimicrobial Susceptibility Reporting Form (PDF document - 76 KB - 1 page)

Organization: Public Health Agency of Canada

Date published: 2015-02-04

Appendix III: Data Tables

Table 1: Critical concentrations for routine testing of anti-tuberculosis drugs
Anti-tuberculosis drugs Critical concentrationsTable 1 Footnote * (mg/L) BACTEC®  960 Comments

Table 1 Footnotes

Table 1 Footnote 1

Critical concentrations: the lowest concentration of drug that will inhibit 95% of wild strains of Mycobacterium tuberculosis that have never been exposed to drugs while at the same time not inhibiting strains of Mycobacterium tuberculosis that have been isolated from patients who are not responding to therapy and that are considered resistant.

Return to Table 1 footnote * referrer

First-line Isoniazid (INH) 0.1 When resistance to INH is 0.1 mg/L, tests are repeated with INH 0.4 mg/L to determine the level of resistance. Nevertheless, the isolate is reported as resistant using the 0.1 mg/L cut-off level.
Rifampin (RMP) 1.0  
Ethambutol (EMB) 5.0  
Pyrazinamide (PZA) 100.0 Routine testing is not performed for isolates from British Columbia.
Second-line Amikacin (AK) 1.0  
Capreomycin (CM) 2.5  
Ethionamide (ETH) 5.0  
Kanamycin (KM) 2.5  
Linezolid (LIN) 1.0  
Moxifloxacin (MOX) 0.3  
Ofloxacin (OFL) 2.0  
Para-aminosalicylic acid (PAS) 4.0  
Rifabutin (RBT) 0.5  
Streptomycin (SM) 1.0  
Table 2: Total number of Mycobacterium tuberculosis complex isolates by reporting and originating province/territory, 2014
Reporting province Canada Originating province
N.L. P.E.I. N.S. N.B. Que. Ont. Man. Sask. Alta. B.C. Y.T. N.W.T Nvt.
N.L. 6 6 0 0 0 0 0 0 0 0 0 0 0 0
N.S. 10 0 2 8 0 0 0 0 0 0 0 0 0 0
N.B. 6 0 0 0 6 0 0 0 0 0 0 0 0 0
Que. 183 0 0 0 0 183 0 0 0 0 0 0 0 0
Ont. 523 0 0 0 0 3 457 0 0 0 2 0 0 61
Man. 125 0 0 0 0 0 0 125 0 0 0 0 0 0
Sask. 63 0 0 0 0 0 0 0 63 0 0 0 0 0
Alta. 188 0 0 0 0 0 0 0 0 180 1 0 2 5
B.C. 272 0 0 0 0 0 0 0 0 1 267 4 0 0
TOTAL 1,376 6 2 8 6 186 457 125 63 181 270 4 2 66
Table 3: Total number of Mycobacterium tuberculosis complex isolates and number and percentage identified with any resistance, as multidrug and as extensively drug resistant in Canada, 2004 to 2014
Reporting year Total number of reported MTBC isolates Resistant to one or more first line drugs Multidrug-resistant TBTable 3 Footnote * Extensively drug-resistant TBTable 3 Footnote
Number  Percent (%) Number  Percent (%) Number  Percent (%)

Abbreviations: MTBC= Mycobacterium tuberculosis complex

Table 3 Footnotes

Table 3 Footnote 1

Multidrug-resistant TB is TB that is resistant to isoniazid and rifampin, but does not meet the definition of extensively drug-resistant TB.

Return to Table 3 footnote * referrer

Table 3 Footnote 2

Extensively drug-resistant TB is TB that is resistant to isoniazid and rifampin, any fluoroquinolone and at least one of three injectable second-line drugs (amikacin, capreomycin and kanamycin).

Return to Table 3 footnote referrer

2004 1,376 119 8.6 12 0.9 0 0.0
2005 1,335 128 9.6 22 1.6 0 0.0
2006 1,389 126 9.1 15 1.1 1 0.1
2007 1,267 133 10.5 11 0.9 0 0.0
2008 1,356 116 8.6 15 1.1 1 0.1
2009 1,331 127 9.5 18 1.4 0 0.0
2010 1,279 112 8.8 17 1.3 1 0.1
2011 1,319 139 10.5 18 1.4 1 0.1
2012 1,404 139 9.9 8 0.6 1 0.1
2013 1,381 112 8.1 14 1.0 1 0.1
2014 1,376 131 9.5 18 1.3 1 0.1
TOTAL 14,813 1,382 9.3 168 1.1 7 <0.1
Table 4: Overall pattern of reported tuberculosis drug resistance in Canada, 2004 to 2014
  Reporting year
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 TOTAL
n % n % n % n % n % n % n % n % n % n % n % n %

Table 1 Footnotes

Table 4 Footnote 1

Not all isolates were tested for resistance to pyrazinamide. The percentage shown with any resistance is based on the number tested by year: 2004 = 1,105; 2005 = 1,063; 2006 = 1,080; 2007 = 991; 2008 = 1,048; 2009 = 1,042; 2010 = 1,042; 2011 = 1,197; 2012 = 1,175; 2013 = 1,187; 2014 = 1,143.

Return to Table 4 footnote * referrer

Table 4 Footnote 2

Multidrug-resistant TB is TB that is resistant to isoniazid and rifampin, but does not meet the definition of extensively drug-resistant TB.

Return to Table 4 footnote referrer

Table 4 Footnote 3

Extensively drug-resistant TB is TB that is resistant to isoniazid and rifampin, any fluoroquinolone and at least one of three injectable second–line drugs (amikacin, capreomycin and kanamycin).

Return to Table 4 footnote referrer

Total number of isolates tested 1,376 100.0 1,335 100.0 1,389 100.0 1,267 100.0 1,356 100.0 1,331 100.0 1,279 100.0 1,319 100.0 1,404 100.0 1,381 100.0 1,376 100.0 14,813 100.0
Isolates tested that were susceptible 1,257 91.4 1,207 90.4 1,263 90.9 1,134 89.5 1,240 91.4 1,204 90.5 1,167 91.2 1,180 89.5 1,265 90.1 1,269 91.9 1,245 90.5 13,431 90.7
Isolates showing any resistance to first-line drugs
Any resistance to isoniazid 102 7.4 109 8.2 101 7.3 110 8.7 102 7.5 113 8.5 101 7.9 122 9.2 111 7.9 93 6.7 107 7.8 1,171 7.9
Any resistance  to rifampin 14 1.0 24 1.8 24 1.7 13 1.0 19 1.4 21 1.6 18 1.4 21 1.6 10 0.7 17 1.2 24 1.7 205 1.4
Any resistance to ethambutol 11 0.8 20 1.5 12 0.9 23 1.8 13 1.0 17 1.3 10 0.8 9 0.7 4 0.3 10 0.7 6 0.4 135 0.9
Any resistance to pyrazinamideTable 4 Footnote * 26 2.4 22 2.1 16 1.5 27 2.7 22 1.7 18 2.4 25 2.6 28 2.4 33 2.4 26 2.2 30 2.6 273 2.6
Isolates resistant to one or more first-line TB drugs 119 8.6 128 9.6 126 9.1 133 10.5 116 8.6 127 9.5 112 8.8 139 10.5 139 9.9 112 8.1 131 9.5 1,382 9.3
Monoresistant 94 6.8 103 7.7 107 7.7 111 8.8 94 6.9 98 7.4 88 6.9 119 9.0 128 9.1 93 6.7 108 7.8 1,143 7.7
Multidrug-resistantTable 4 Footnote 12 0.9 22 1.6 15 1.1 11 0.9 15 1.1 18 1.4 17 1.3 18 1.4 8 0.6 14 1.0 18 1.3 168 1.1
Polyresistant 13 0.9 3 0.2 3 0.2 11 0.9 6 0.4 11 0.8 6 0.5 1 0.1 2 0.1 4 0.3 4 0.3 64 0.4
Extensively drug-resistantTable 4 Footnote 0 0.0 0 0.0 1 0.1 0 0.0 1 0.1 0 0.0 1 0.1 1 0.1 1 0.1 1 0.1 1 0.1 7 <0.1
Table 5: Results for routine drug susceptibility testing of Mycobacterium tuberculosis complex isolates to anti-tuberculosis drugs for Alberta, 2004 to 2014
  Reporting year
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
n % n % n % n % n % n % n % n % n % n % n %

Abbreviations: AK=amikacin;EMB=ethambutol; ETH=ethionamide; INH=isoniazid; KM=kanamycin; MOX=moxifloxacin; OFL=ofloxacin; PAS=para-aminosalicylic acid; PZA=pyrazinamide; RBT=rifabutin; RMP=rifampin; SM=streptomycin.

Table 5 Footnotes

Table 5 Footnote 1

Includes Mycobacterium africanum isolate: 1 in 2011, 2013 and 2014, 2 in 2007 and 2009, and 3 in 2010; Mycobacterium bovis: 1 in 2012, 2 in 2009, 2011 and 2013.

Return to Table 5 footnote * referrer

Table 5 Footnote 2

Multidrug-resistant TB is TB that is resistant to isoniazid and rifampin, but does not meet the definition of extensively drug-resistant TB.

Return to Table 5 footnote referrer

Isolates tested for resistance to INH, RMP, EMB & PZA Table 5 Footnote * 94 100.0 129 100.0 104 100.0 98 100.0 134 100.0 159 100.0 107 100.0 156 100.0 163 100.0 154 100.0 181 100.0
Isolates susceptible to all first-line TB drugs 82 87.2 115 89.1 95 91.3 92 93.9 123 91.8 145 91.2 96 89.7 133 85.3 148 90.8 140 90.9 165 91.2
Resistant to one or more first line drugs 12 12.8 14 10.9 9 8.7 6 6.1 11 8.2 14 8.8 11 10.3 23 14.7 15 9.2 14 9.1 16 8.8
Monoresistant TB
INH 7 7.4 10 7.8 7 6.7 5 5.1 8 6.0 8 5.0 6 5.6 14 9.0 10 6.1 9 5.8 11 6.1
RMP 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.6 0 0.0 0 0.0 0 0.0 0 0.0 1 0.6
EMB 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
PZA 2 2.1 0 0.0 1 1.0 1 1.0 0 0.0 3 1.9 0 0.0 2 1.3 3 1.8 4 2.6 0 0.0
Total 9 9.6 10 7.8 8 7.7 6 6.1 8 6.0 12 7.5 6 5.6 16 10.3 13 8.0 13 8.4 12 6.6
Polyresistant
INH & PZA 1 1.1 0 0.0 0 0.0 0 0.0 0 0.0 1 0.6 1 0.9 0 0.0 1 0.6 0 0.0 0 0.0
INH & EMB 0 0.0 0 0.0 0 0.0 0 0.0 1 0.7 1 0.6 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
INH & EMB & PZA 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.9 0 0.0 0 0.0 1 0.6 0 0.0
Total 1 1.1 0 0.0 0 0.0 0 0.0 1 0.7 2 1.3 2 1.9 0 0.0 1 0.6 1 0.6 0 0.0
Multidrug-resistant TBTable 5 Footnote
INH & RMP 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.6 0 0.0 0 0.0 0 0.0
INH & RMP & EMB 0 0.0 1 0.8 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & EMB & AK & KM & RBT 1 1.1 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & EMB & PZA 0 0.0 1 0.8 0 0.0 0 0.0 1 0.7 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & EMB & PZA & RBT 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.6
INH & RMP & EMB & PZA & SM 0 0.0 1 0.8 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & EMB & PZA & SM & OFL & MOX & ETH & RBT 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.6
INH & RMP & EMB & PZA & SM & RBT 0 0.0 0 0.0 0 0.0 0 0.0 1 0.7 0 0.0 1 0.9 1 0.6 0 0.0 0 0.0 0 0.0
INH & RMP & EMB & SM 0 0.0 0 0.0 1 1.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & EMB & SM & OFL 1 1.1 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & ETH & RBT 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 2 1.3 0 0.0 0 0.0 1 0.6
INH & RMP & PZA & SM & ETH 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.6 0 0.0 0 0.0 0 0.0
INH & RMP & PZA & SM & OFL & RBT 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.9 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & PZA & SM & RBT 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.9 1 0.6 0 0.0 0 0.0 0 0.0
INH & RMP & RBT 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.6 0 0.0 0 0.0 0 0.0
INH & RMP & SM 0 0.0 1 0.8 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & SM & ETH & RBT 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.6
INH & RMP & SM & RBT 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.6 0 0.0 0 0.0
Total 2 2.1 4 3.1 1 1.0 0 0.0 2 1.5 0 0.0 3 2.8 7 4.5 1 0.6 0 0.0 4 2.2
Table 6: Results for routine drug susceptibility testing of Mycobacterium tuberculosis complex isolates to anti-tuberculosis drugs for British Columbia, 2004 to 2014
  Reporting year
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
n % n % n % n % n % n % n % n % n % n % n %

Abbreviations: CM=capreomycin; EMB=ethambutol; ETH=ethionamide; INH=isoniazid; KM=kanamycin; MOX=moxifloxacin; OFL=ofloxacin; PAS=para-aminosalicylic acid; PZA=pyrazinamide; RBT=rifabutin; RMP=rifampin; SM=streptomycin.

Table 6 Footnotes

Table 6 Footnote 1

Includes Mycobacterium bovis isolates: 1 in 2006 and 2007; Mycobacterium africanum: 1 in 2008, 2009 and 2014; 5 in 2012 and 2013.

Return to Table 6 footnote * referrer

Table 6 Footnote 2

Routine testing for PZA not conducted in British Columbia.

Return to Table 6 footnote referrer

Table 6 Footnote 3

Multidrug-resistant TB is TB that is resistant to isoniazid and rifampin, but does not meet the definition of extensively drug-resistant TB.

Return to Table 6 footnote referrer

Isolates tested for resistance to INH, RMP, EMBTable 6 Footnote *,Table 6 Footnote 263 100.0 204 100.0 275 100.0 231 100.0 254 100.0 239 100.0 204 100.0 194 100.0 254 100.0 223 100.0 270 100.0
Isolates susceptible to all first-line TB drugs 237 90.1 182 89.2 257 93.5 210 90.9 230 90.6 215 90.0 185 90.7 170 87.6 231 90.9 204 91.5 235 87.0
Resistant to one or more first line drugs 26 9.9 22 10.8 18 6.5 21 9.1 24 9.4 24 10.0 19 9.3 24 12.4 23 9.1 19 8.5 35 13.0
Monoresistant TB
INH 13 4.9 11 5.4 7 2.5 13 5.6 18 7.1 22 9.2 16 7.8 21 10.8 21 8.3 19 8.5 25 9.3
RMP 0 0.0 2 1.0 6 2.2 0 0.0 3 1.2 1 0.4 0 0.0 1 0.5 0 0.0 0 0.0 2 0.7
EMB  1 0.4 4 2.0 3 1.1 4 1.7 0 0.0 0 0.0 1 0.5 0 0.0 0 0.0 0 0.0 0 0.0
PZA 3 1.1 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.5 0 0.0 0 0.0 0 0.0 0 0.0
Total 17 6.5 17 8.3 16 5.8 17 7.4 21 8.3 23 9.6 18 8.8 22 11.3 21 8.3 19 8.5 27 10.0
Polyresistant
RMP & PZA 2 0.8 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
INH & PZA 4 1.5 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.5 0 0.0 0 0.0 2 0.7
INH & EMB 1 0.4 1 0.5 0 0.0 2 0.9 0 0.0 1 0.4 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
Total 7 2.7 1 0.5 0 0.0 2 0.9 0 0.0 1 0.4 0 0.0 1 0.5 0 0.0 0 0.0 2 0.7
Multidrug-resistant TBTable 6 Footnote
INH & RMP 0 0.0 0 0.0 1 0.4 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & EMB & PZA & ETH & RBT 1 0.4 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & EMB & PZA & KM & CM & ETH & RBT 0 0.0 0 0.0 0 0.0 1 0.4 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & EMB & PZA & PAS 0 0.0 0 0.0 0 0.0 0 0.0 1 0.4 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & EMB & PZA & RBT 0 0.0 0 0.0 0 0.0 0 0.0 1 0.4 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & EMB & PZA & SM & ETH & RBT & PAS 0 0.0 0 0.0 1 0.4 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & EMB & PZA & SM & KM & RBT 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.4 0 0.0 0 0.0
INH & RMP & EMB & PZA & SM & OFL & ETH & RBT & PAS 0 0.0 0 0.0 0 0.0 1 0.4 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & EMB & PZA & SM & RBT 0 0.0 1 0.5 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & EMB & RBT 1 0.4 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & EMB & SM & ETH & RBT 0 0.0 1 0.5 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.4
INH & RMP & EMB & SM & ETH & RBT & PAS 0 0.0 1 0.5 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & ETH & RBT 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.4
INH & RMP & PZA & RBT 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.4
INH & RMP & PZA & SM & RBT 0 0.0 1 0.5 0 0.0 0 0.0 0 0.0 0 0.0 1 0.5 0 0.0 1 0.4 0 0.0 0 0.0
INH & RMP & PZA & SM & RBT & PAS 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.5 0 0.0 0 0.0 0 0.0
INH & RMP & RBT 0 0.0 0 0.0 0 0.0 0 0.0 1 0.4 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 2 0.7
INH & RMP & SM & RBT 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.4
Total 2 0.8 4 2.0 2 0.7 2 0.9 3 1.2 0 0.0 1 0.5 1 0.5 2 0.8 0 0.0 6 2.2
Table 7: Results for routine drug susceptibility testing of Mycobacterium tuberculosis complex isolates to anti-tuberculosis drugs for Manitoba, 2004 to 2014
  Reporting year
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
n % n % n % n % n % n % n % n % n % n % n %

Abbreviations: CM=capreomycin; EMB=ethambutol; ETH=ethionamide; INH=isoniazid; KM=kanamycin; MOX=moxifloxacin; OFL=ofloxacin; PAS=para-aminosalicylic acid; PZA=pyrazinamide; RBT=rifabutin; RMP=rifampin; SM=streptomycin.

Table 7 Footnotes

Table 7 Footnote 1

Includes Mycobacterium bovis isolates: 1 in 2006 and 2007; Mycobacterium africanum: 1 in 2008.

Return to Table 7 footnote * referrer

Table 7 Footnote 2

Multidrug-resistant TB is TB that is resistant to isoniazid and rifampin, but does not meet the definition of extensively drug-resistant TB.

Return to Table 7 footnote referrer

Table 7 Footnote 3

Extensively drug-resistant TB is TB that is resistant to isoniazid and rifampin, any fluoroquinolone and at least one of three injectable second–line drugs (amikacin, capreomycin and kanamycin).

Return to Table 7 footnote referrer

Isolates tested for resistance to INH, RMP, EMB & PZATable 7 Footnote * 122 100.0 94 100.0 119 100.0 84 100.0 116 100.0 106 100.0 113 100.0 97 100.0 123 100.0 148 100.0 125 100.0
Isolates susceptible to all first-line TB drugs 121 99.2 92 97.9 113 95.0 75 89.3 111 95.7 99 93.4 99 87.6 90 92.8 113 91.9 144 97.3 120 96.0
Resistant to one or more first line drugs 1 0.8 2 2.1 6 5.0 9 10.7 5 4.3 7 6.6 14 12.4 7 7.2 10 8.1 4 2.7 5 4.0
Monoresistant TB
INH 0 0.0 2 2.1 6 5.0 7 8.3 4 3.4 4 3.8 10 8.8 5 5.2 10 8.1 4 2.7 5 4.0
RMP 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
EMB  0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
PZA 1 0.8 0 0.0 0 0.0 1 1.2 0 0.0 1 0.9 1 0.9 0 0.0 0 0.0 0 0.0 0 0.0
Total 1 0.8 2 2.1 6 5.0 8 9.5 4 3.4 5 4.7 11 9.7 5 5.2 10 8.1 4 2.7 5 4.0
Polyresistant
INH & PZA 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.9 1 0.9 0 0.0 0 0.0 0 0.0 0 0.0
INH & EMB 0 0.0 0 0.0 0 0.0 1 1.2 0 0.0 1 0.9 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
Total 0 0.0 0 0.0 0 0.0 1 1.2 0 0.0 2 1.9 1 0.9 0 0.0 0 0.0 0 0.0 0 0.0
Multidrug-resistant TBTable 7 Footnote
INH & RMP 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.9 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & EMB & PZA & SM & AK & KM & CM & ETH & PAS 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 1.0 0 0.0 0 0.0 0 0.0
INH & RMP & PZA & SM & RBT 0 0.0 0 0.0 0 0.0 0 0.0 1 0.9 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & RBT 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 1.0 0 0.0 0 0.0 0 0.0
Total 0 0.0 0 0.0 0 0.0 0 0.0 1 0.9 0 0.0 1 0.9 2 2.1 0 0.0 0 0.0 0 0.0
Extensively drug-resistant
INH & RMP & EMB & PZA & KM & OFL & ETH & RBT 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.9 0 0.0 0 0.0 0 0.0 0 0.0
Total 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.9 0 0.0 0 0.0 0 0.0 0 0.0
Table 8: Results for routine drug susceptibility testing of Mycobacterium tuberculosis complex isolates to anti-tuberculosis drugs for New Brunswick, 2004 to 2014
  Reporting year
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
n % n % n % n % n % n % n % n % n % n % n %

Abbreviations: EMB=ethambutol; INH=isoniazid; PZA=pyrazinamide; RMP=rifampin.

Table 8 Footnotes

Table 8 Footnote 1

Includes 1 Mycobacterium africanum isolate for 2007

Return to Table 8 footnote * referrer

Isolates tested for resistance to INH, RMP, EMB & PZATable 8 Footnote * 11 100.0 5 100.0 3 100.0 5 100.0 3 100.0 10 100.0 9 100.0 5 100.0 4 100.0 3 100.0 6 100.0
Isolates susceptible to all first-line TB drugs 10 90.9 4 80.0 3 100.0 5 100.0 3 100.0 10 100.0 7 77.8 5 100.0 3 75.0 2 66.7 6 100.0
Resistant to one or more first line drugs 1 9.1 1 20.0 0 0.0 0 0.0 0 0.0 0 0.0 2 22.2 0 0.0 1 25.0 1 33.3 0 0.0
Monoresistant TB
INH 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 2 22.2 0 0.0 0 0.0 1 33.3 0 0.0
RMP 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
EMB 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
PZA 1 9.1 1 20.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 25.0 0 0.0 0 0.0
Total 1 9.1 1 20.0 0 0.0 0 0.0 0 0.0 0 0.0 2 22.2 0 0.0 1 25.0 1 33.3 0 0.0
Table 9: Results for routine drug susceptibility testing of Mycobacterium tuberculosis complex isolates to anti-tuberculosis drugs for Newfoundland and Labrador, 2004 to 2014
  Reporting year
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
n % n % n % n % n % n % n % n % n % n % n %

Abbreviations: EMB=ethambutol; INH=isoniazid; PZA=pyrazinamide; RMP=rifampin.

Isolates tested for resistance to INH, RMP, EMB & PZA 8 100.0 6 100.0 11 100.0 5 100.0 5 100.0 10 100.0 9 100.0 5 100.0 5 100.0 11 100.0 6 100.0
Isolates susceptible to all first-line TB drugs 8 100.0 5 83.3 11 100.0 5 100.0 5 100.0 10 100.0 9 100.0 5 100.0 5 100.0 11 100.0 6 100.0
Resistant to one or more first line drugs 0 0.0 1 16.7 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
Monoresistant TB
INH 0 0.0 1 16.7 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
RMP 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
EMB 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
PZA 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
Total 0 0.0 1 16.7 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
Table 10: Results for routine drug susceptibility testing of Mycobacterium tuberculosis complex isolates to anti-tuberculosis drugs for Northwest Territories, 2004 to 2014
  Reporting year
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
n % n % n % n % n % n % n % n % n % n % n %

Abbreviations: EMB=ethambutol; INH=isoniazid; PZA=pyrazinamide; RMP=rifampin.

Isolates tested for resistance to INH, RMP, EMB & PZA 9 100.0 6 100.0 4 100.0 14 100.0 13 100.0 10 100.0 5 100.0 8 100.0 6 100.0 3 100.0 2 100.0
Isolates susceptible to all first-line TB drugs 9 100.0 6 100.0 3 75.0 14 100.0 13 100.0 9 90.0 4 80.0 8 100.0 6 100.0 3 100.0 2 100.0
Resistant to one or more first line drugs 0 0.0 0 0.0 1 25.0 0 0.0 0 0.0 1 10.0 1 20.0 0 0.0 0 0.0 0 0.0 0 0.0
Monoresistant TB
INH 0 0.0 0 0.0 1 25.0 0 0.0 0 0.0 0 0.0 1 20.0 0 0.0 0 0.0 0 0.0 0 0.0
RMP 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 10.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
EMB 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
PZA 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
Total 0 0.0 0 0.0 1 25.0 0 0.0 0 0.0 1 10.0 1 20.0 0 0.0 0 0.0 0 0.0 0 0.0
Table 11: Results for routine drug susceptibility testing of Mycobacterium tuberculosis complex isolates to anti-tuberculosis drugs for Nova Scotia, 2004 to 2014
  Reporting year
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
n % n % n % n % n % n % n % n % n % n % n %

Abbreviations:  EMB=ethambutol; INH=isoniazid;  PZA=pyrazinamide;  RMP=rifampin.

Table 1 Footnotes

Table 11 Footnote 1

Includes 1 Mycobacterium bovis isolate for 2010.

Return to Table 11 footnote * referrer

Isolates tested for resistance to INH, RMP, EMB & PZATable 11 Footnote * 9 100.0 7 100.0 8 100.0 5 100.0 3 100.0 7 100.0 8 100.0 7 100.0 9 100.0 9 100.0 8 100.0
Isolates susceptible to all first-line TB drugs 9 100.0 6 85.7 8 100.0 5 100.0 3 100.0 7 100.0 5 62.5 7 100.0 9 100.0 8 88.9 5 62.5
Resistant to one or more first line drugs 0 0.0 1 14.3 0 0.0 0 0.0 0 0.0 0 0.0 3 37.5 0 0.0 0 0.0 1 11.1 3 37.5
Monoresistant TB
INH 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 12.5 0 0.0 0 0.0 1 11.1 3 37.5
RMP 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
EMB 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
PZA 0 0.0 1 14.3 0 0.0 0 0.0 0 0.0 0 0.0 1 12.5 0 0.0 0 0.0 0 0.0 0 0.0
Total 0 0.0 1 14.3 0 0.0 0 0.0 0 0.0 0 0.0 2 25.0 0 0.0 0 0.0 1 11.1 3 37.5
Polyresistant
INH & PZA 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 12.5 0 0.0 0 0.0 0 0.0 0 0.0
Total 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 12.5 0 0.0 0 0.0 0 0.0 0 0.0
Table 12: Results for routine drug susceptibility testing of Mycobacterium tuberculosis complex isolates to anti-tuberculosis drugs for Nunavut, 2004 to 2014
  Reporting year
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
n % n % n % n % n % n % n % n % n % n % n %

Abbreviations: EMB=ethambutol; INH=isoniazid; PZA=pyrazinamide; RMP=rifampin.

Isolates tested for resistance to INH, RMP, EMB & PZA 16 100.0 28 100.0 37 100.0 25 100.0 51 100.0 50 100.0 71 100.0 64 100.0 65 100.0 42 100.0 66 100.0
Isolates susceptible to all first-line TB drugs 16 100.0 28 100.0 37 100.0 24 96.0 51 100.0 49 98.0 70 98.6 62 96.9 65 100.0 42 100.0 66 100.0
Resistant to one or more first line drugs 0 0.0 0 0.0 0 0.0 1 4.0 0 0.0 1 2.0 1 1.4 2 3.1 0 0.0 0 0.0 0 0.0
Monoresistant TB
INH 0 0.0 0 0.0 0 0.0 1 4.0 0 0.0 1 2.0 1 1.4 1 1.6 0 0.0 0 0.0 0 0.0
RMP 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 1.6 0 0.0 0 0.0 0 0.0
EMB 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
PZA 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
Total 0 0.0 0 0.0 0 0.0 1 4.0 0 0.0 1 2.0 1 1.4 2 3.1 0 0.0 0 0.0 0 0.0
Table 13: Results for routine drug susceptibility testing of Mycobacterium tuberculosis complex isolates to anti-tuberculosis drugs for Ontario, 2004 to 2014
  Reporting year
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
n % n % n % n % n % n % n % n % n % n % n %

Abbreviations:  AK=amikacin; CM=capreomycin; EMB=ethambutol; ETH=ethionamide; INH=isoniazid; KM=kanamycin;  MOX=moxifloxacin; OFL=ofloxacin; PAS=para-aminosalicylic acid; PZA=pyrazinamide; RBT=rifabutin; RMP=rifampin; SM=streptomycin.

Table 1 Footnotes

Table 13 Footnote 1

Includes Mycobacterium bovis isolates: 1 isolate for 2004 and 2014; 2 for 2009, 2005 and 2010; 3 for 2011, and 4 for 2006.

Return to Table 13 footnote * referrer

Table 13 Footnote 2

Multidrug-resistant TB is TB that is resistant to isoniazid and rifampin, but does not meet the definition of extensively drug-resistant TB.

Return to Table 13 footnote referrer

Table 13 Footnote 3

Extensively drug-resistant TB is TB that is resistant to isoniazid and rifampin, any fluoroquinolone and at least one of three injectable second–line drugs (amikacin, capreomycin and kanamycin).

Return to Table 13 footnote referrer

Isolates tested for resistance to INH, RMP, EMB & PZATable 13 Footnote * 599 100.0 553 100.0 567 100.0 538 100.0 479 100.0 488 100.0 496 100.0 507 100.0 493 100.0 511 100.0 457 100.0
Isolates susceptible to all first-line TB drugs 539 90.0 487 88.1 504 88.9 466 86.6 427 89.1 428 87.7 456 91.9 454 89.5 429 87.0 458 89.6 407 89.1
Resistant to one or more first line drugs 60 10.0 66 11.9 63 11.1 72 13.4 52 10.9 60 12.3 40 8.1 53 10.5 64 13.0 53 10.4 50 10.9
Monoresistant TB
INH 46 7.7 44 8.0 39 6.9 50 9.3 33 6.9 39 8.0 27 5.4 39 7.7 45 9.1 27 5.3 30 6.6
RMP 0 0.0 0 0.0 1 0.2 1 0.2 0 0.0 0 0.0 0 0.0 0 0.0 1 0.2 2 0.4 1 0.2
EMB  0 0.0 0 0.0 0 0.0 1 0.2 1 0.2 1 0.2 0 0.0 0 0.0 1 0.2 0 0.0 0 0.0
PZA 3 0.5 7 1.3 9 1.6 9 1.7 6 1.3 4 0.8 2 0.4 6 1.2 10 2.0 8 1.6 11 2.4
Total 49 8.2 51 9.2 49 8.6 61 11.3 40 8.4 44 9.0 29 5.8 45 8.9 57 11.6 37 7.2 42 9.2
Polyresistant
EMB & PZA 0 0.0 0 0.0 0 0.0 1 0.2 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
INH & EMB 3 0.5 2 0.4 3 0.5 1 0.2 2 0.4 3 0.6 0 0.0 0 0.0 0 0.0 1 0.2 0 0.0
INH & PZA 1 0.2 0 0.0 0 0.0 2 0.4 0 0.0 0 0.0 1 0.2 0 0.0 1 0.2 2 0.4 1 0.2
INH & EMB & PZA 0 0.0 0 0.0 0 0.0 0 0.0 2 0.4 2 0.4 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
Total 4 0.7 2 0.4 3 0.5 4 0.7 4 0.8 5 1.0 1 0.2 0 0.0 1 0.2 3 0.6 1 0.2
Multidrug-resistant TBTable 13 Footnote
INH & RMP 1 0.2 0 0.0 2 0.4 0 0.0 0 0.0 1 0.2 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & AK & CM & RBT 0 0.0 0 0.0 1 0.2 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & CM & ETH & RBT 1 0.2 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & CM & RBT 0 0.0 0 0.0 1 0.2 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & EMB & ETH & RBT 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.2 0 0.0
INH & RMP & EMB & PZA & AK & CM & ETH & RBT 0 0.0 0 0.0 0 0.0 1 0.2 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & EMB & PZA & CM & RBT 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.2 0 0.0 0 0.0
INH & RMP & EMB & PZA & ETH & RBT 0 0.0 0 0.0 0 0.0 2 0.4 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & EMB & PZA & RBT 0 0.0 0 0.0 0 0.0 1 0.2 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.2
INH & RMP & EMB & PZA & RBT & PAS 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.2 0 0.0 0 0.0 0 0.0
INH & RMP & EMB & PZA & SM 0 0.0 1 0.2 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.2 0 0.0 0 0.0 0 0.0
INH & RMP & EMB & PZA & SM & ETH & RBT 0 0.0 1 0.2 0 0.0 0 0.0 0 0.0 0 0.0 1 0.2 1 0.2 0 0.0 1 0.2 0 0.0
INH & RMP & EMB & PZA & SM & ETH & RBT & PAS 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.2 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & EMB & PZA & SM & OFL & ETH & RBT 1 0.2 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & EMB & PZA & SM & OFL & MOX & ETH & RBT 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.2 0 0.0
INH & RMP & EMB & PZA & SM & OFL & RBT 0 0.0 1 0.2 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & EMB & PZA & SM & RBT 0 0.0 0 0.0 0 0.0 1 0.2 1 0.2 1 0.2 0 0.0 1 0.2 0 0.0 1 0.2 0 0.0
INH & RMP & EMB & RBT 0 0.0 0 0.0 2 0.4 1 0.2 1 0.2 2 0.4 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & EMB & SM & AK & CM 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.2 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & EMB & SM & ETH & RBT 0 0.0 1 0.2 0 0.0 0 0.0 0 0.0 1 0.2 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & EMB & SM & ETH & RBT & PAS 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.2 0 0.0
INH & RMP & EMB & SM & KM & RBT & PAS 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.2 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & EMB & SM & OFL & ETH & RBT 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.2 1 0.2 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & EMB & SM & OFL & MOX & ETH & RBT 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.2 0 0.0 0 0.0 0 0.0
INH & RMP & EMB & SM & OFL & RBT 0 0.0 1 0.2 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & EMB & SM & RBT 0 0.0 2 0.4 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.2 1 0.2
INH & RMP & ETH & RBT 0 0.0 0 0.0 1 0.2 0 0.0 1 0.2 1 0.2 0 0.0 0 0.0 0 0.0 1 0.2 0 0.0
INH & RMP & ETH & RBT & PAS 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.2 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & OFL & ETH & RBT 2 0.3 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & OFL & ETH & RBT & PAS 0 0.0 0 0.0 1 0.2 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & PZA & ETH & RBT 0 0.0 1 0.2 1 0.2 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & PZA & RBT 1 0.2 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & PZA & SM 1 0.2 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & PZA & SM & ETH & RBT 0 0.0 0 0.0 0 0.0 1 0.2 1 0.2 1 0.2 1 0.2 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & PZA & SM & OFL & MOX & RBT 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.2 0 0.0 0 0.0
INH & RMP & PZA & SM & RBT 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.2 0 0.0 1 0.2 1 0.2
INH & RMP & RBT 0 0.0 3 0.5 1 0.2 0 0.0 0 0.0 0 0.0 1 0.2 0 0.0 0 0.0 2 0.4 0 0.0
INH & RMP & SM 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.2 1 0.2 0 0.0
INH & RMP & SM & CM & RBT 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.2
INH & RMP & SM & ETH & RBT 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.2 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & SM & ETH & RBT & PAS 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.2
INH & RMP & SM & KM & ETH & RBT 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.2 0 0.0 0 0.0
INH & RMP & SM & OFL & ETH & RBT 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.2 1 0.2 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & SM & RBT 0 0.0 2 0.4 0 0.0 0 0.0 3 0.6 1 0.2 1 0.2 1 0.2 1 0.2 2 0.4 1 0.2
Total 7 1.2 13 2.4 10 1.8 7 1.3 7 1.5 11 2.3 10 2.0 7 1.4 5 1.0 13 2.5 6 1.3
Extensively drug-resistant TBTable 13 Footnote
INH & RMP & AK & CM & OFL & ETH & RBT 0 0.0 0 0.0 1 0.2 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & EMB & PZA & CM & OFL & ETH & RBT & PAS 0 0.0 0 0.0 0 0.0 0 0.0 1 0.2 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & EMB & PZA & SM & KM & OFL & MOX & ETH & RBT 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.2 0 0.0 0 0.0
INH & RMP & EMB & PZA & SM & KM & OFL & MOX & ETH & RBT & PAS 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.2 0 0.0 0 0.0 0 0.0
INH & RMP & EMB & PZA & SM & KM & OFL & MOX & RBT & ETA & PAS 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.2
Total 0 0.0 0 0.0 1 0.2 0 0.0 1 0.2 0 0.0 0 0.0 1 0.2 1 0.2 0 0.0 1 0.2
Table 14: Results for routine drug susceptibility testing of Mycobacterium tuberculosis complex isolates to anti-tuberculosis drugs for Prince Edward Island, 2004 to 2014
  Reporting year
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
n % n % n % n % n % n % n % n % n % n % n %
Isolates tested for resistance to INH, RMP, EMB & PZA 1 100.0 1 100.0 0 0 0 0 0 0 1 100.0 1 100.0 3 100.0 0 0 0 0 2 100.0
Isolates susceptible to all first-line TB drugs 1 100.0 1 100.0 0 0 0 0 0 0 1 100.0 1 100.0 2 66.7 0 0 0 0 2 100.0
Resistant to one or more first line drugs 0 0.0 0 0.0 0 0 0 0 0 0 0 0.0 0 0.0 1 33.3 0 0 0 0 0 0.0
Monoresistant TB
INH 0 0.0 0 0.0 0 0 0 0 0 0 0 0.0 0 0.0 0 0.0 0 0 0 0 0 0.0
RMP 0 0.0 0 0.0 0 0 0 0 0 0 0 0.0 0 0.0 0 0.0 0 0 0 0 0 0.0
EMB 0 0.0 0 0.0 0 0 0 0 0 0 0 0.0 0 0.0 0 0.0 0 0 0 0 0 0.0
PZA 0 0.0 0 0.0 0 0 0 0 0 0 0 0.0 0 0.0 1 33.3 0 0 0 0 0 0.0
Total 0 0.0 0 0.0 0 0 0 0 0 0 0 0.0 0 0.0 1 33.3 0 0 0 0 0 0.0
Table 15: Results for routine drug susceptibility testing of Mycobacterium tuberculosis complex isolates to anti-tuberculosis drugs for Quebec, 2004 to 2014
  Reporting year
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
n % n % n % n % n % n % n % n % n % n % n %

Abbreviations: AK= amikacin; CM= capreomycin; ETH= ethionamide; KM= kanamycin; MOX=moxifloxacin; OFL= ofloxacin; PAS= para-aminosalicylic acid; RBT= rifabutin; RMP= rifampin; SM= streptomycin.

Table 1 Footnotes

Table 15 Footnote 1

Includes Mycobacterium bovis isolates: 1 in 2007, 2009, 2013 and 2014; 2 in 2004, 2006, and 2010; 3 in 2011; 4 in 2012; Mycobacterium caprae: 1 in 2006; Mycobacterium africanum: 1 in 2005, 2006, 2008, and 2014; 2 in 2007, 2012, and 2013; 3 in 2009 and 2011; and 4 in 2010.Includes Mycobacterium bovis isolates: 1 in 2007, 2009, 2013 and 2014; 2 in 2004, 2006, and 2010; 3 in 2011; 4 in 2012; Mycobacterium caprae: 1 in 2006; Mycobacterium africanum: 1 in 2005, 2006, 2008, and 2014; 2 in 2007, 2012, and 2013; 3 in 2009 and 2011; and 4 in 2010.

Return to Table 15 footnote * referrer

Table 15 Footnote 2

Multidrug-resistant TB is TB that is resistant to isoniazid and rifampin, but does not meet the definition of extensively drug-resistant TB.

Return to Table 15 footnote referrer

Table 15 Footnote 3

Extensively drug-resistant TB is TB that is resistant to isoniazid and rifampin, any fluoroquinolone and at least one of three injectable second–line drugs (amikacin, capreomycin and kanamycin).

Return to Table 15 footnote referrer

Isolates tested for resistance to INH, RMP, EMB & PZATable 15 Footnote * 207 100.0 226 100.0 201 100.0 200 100.0 210 100.0 171 100.0 197 100.0 205 100.0 209 100.0 205 100.0 186 100.0
Isolates susceptible to all first-line TB drugs 190 91.8 207 91.6 173 86.1 177 88.5 188 89.5 156 91.2 179 90.9 180 87.8 187 89.5 187 91.2 167 89.8
Resistant to one or more first line drugs 17 8.2 19 8.4 28 13.9 23 11.5 22 10.5 15 8.8 18 9.1 25 12.2 22 10.5 18 8.8 19 10.2
Monoresistant TB
INH 11 5.3 14 6.2 21 10.4 12 6.0 15 7.1 7 4.1 11 5.6 18 8.8 13 6.2 12 5.9 10 5.4
RMP 0 0.0 0 0.0 1 0.5 1 0.5 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
EMB 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
PZA 4 1.9 4 1.8 4 2.0 4 2.0 4 1.9 2 1.2 5 2.5 6 2.9 9 4.3 4 2.0 7 3.8
Total 15 7.2 18 8.0 26 12.9 17 8.5 19 9.0 9 5.3 16 8.1 24 11.7 22 10.5 16 7.8 17 9.1
Polyresistant
INH & PZA  0 0.0 0 0.0 0 0.0 1 0.5 1 0.5 0 0.0 1 0.5 0 0.0 0 0.0 0 0.0 0 0.0
INH & EMB 1 0.5 0 0.0 0 0.0 3 1.5 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
Total 1 0.5 0 0.0 0 0.0 4 2.0 1 0.5 0 0.0 1 0.5 0 0.0 0 0.0 0 0.0 0 0.0
Multidrug-resistant TBTable 15 Footnote
INH & RMP & EMB & ETH & RBT 0 0.0 0 0.0 1 0.5 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & EMB & PZA & RBT 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.6 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & EMB & PZA & SM & ETH 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.5 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & EMB & PZA & SM & KM & ETH & RBT & PAS 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.5 0 0.0
INH & RMP & EMB & PZA & SM & RBT 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.5 0 0.0 0 0.0 0 0.0
INH & RMP & EMB & RBT 0 0.0 0 0.0 0 0.0 1 0.5 0 0.0 1 0.6 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & EMB & SM & RBT 0 0.0 0 0.0 1 0.5 1 0.5 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & PZA & ETH & RBT 0 0.0 1 0.4 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & PZA & RBT 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.5
INH & RMP & PZA & SM & AK & KM & CM 0 0.0 0 0.0 0 0.0 0 0.0 1 0.5 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & PZA & SM & KM & CM & ETH 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.6 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & RBT 1 0.5 0 0.0 0 0.0 0 0.0 0 0.0 1 0.6 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & SM & RBT 0 0.0 0 0.0 0 0.0 0 0.0 1 0.5 2 1.2 0 0.0 0 0.0 0 0.0 0 0.0 1 0.5
Total 1 0.5 1 0.4 2 1.0 2 1.0 2 1.0 6 3.5 1 0.5 1 0.5 0 0.0 1 0.5 2 1.1
Extensively drug-resistant TBTable 15 Footnote
INH & RMP & EMB & PZA & SM & AK & KM & CM & OFL & MOX & ETH & RBT 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.5 0 0.0
Total 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.5 0 0.0
Table 16: Results for routine drug susceptibility testing of Mycobacterium tuberculosis complex isolates to anti-tuberculosis drugs for Saskatchewan, 2004 to 2014
  Reporting year
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
n % n % n % n % n % n % n % n % n % n % n %

Abbreviations:  EMB=ethambutol; INH=isoniazid;  PZA=pyrazinamide; RBT = rifabutin; RMP=rifampin; SM=streptomycin.

Table 16 Footnotes

Table 16 Footnote 1

Multidrug-resistant TB is TB that is resistant to isoniazid and rifampin, but does not meet the definition of extensively drug-resistant TB.

Return to Table 16 footnote * referrer

Isolates tested for resistance to INH, RMP, EMB & PZA 34 100.0 74 100.0 58 100.0 60 100.0 81 100.0 77 100.0 54 100.0 66 100.0 72 100.0 71 100.0 63 100.0
Isolates susceptible to all first-line TB drugs 32 94.1 72 97.3 57 98.3 59 98.3 79 97.5 72 93.5 51 94.4 62 93.9 68 94.4 69 97.2 60 95.2
Resistant to one or more first line drugs 2 5.9 2 2.7 1 1.7 1 1.7 2 2.5 5 6.5 3 5.6 4 6.1 4 5.6 2 2.8 3 4.8
Monoresistant TB
INH 2 5.9 2 2.7 1 1.7 1 1.7 2 2.5 3 3.9 2 3.7 4 6.1 1 1.4 1 1.4 0 0.0
RMP 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 1.6
EMB 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
PZA 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 3 4.2 1 1.4 1 1.6
Total 2 5.9 2 2.7 1 1.7 1 1.7 2 2.5 3 3.9 2 3.7 4 6.1 4 5.6 2 2.8 2 3.2
Polyresistant
INH & PZA 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 1.6
INH & EMB 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 1.3 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
Total 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 1.3 0 0.0 0 0.0 0 0.0 0 0.0 1 1.6
Multidrug-resistant TBTable 16 Footnote *
INH & RMP & RBT 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 1.9 0 0.0 0 0.0 0 0.0 0 0.0
INH & RMP & SM 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 1.3 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
Total 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 1.3 1 1.9 0 0.0 0 0.0 0 0.0 0 0.0
Table 17: Results for routine drug susceptibility testing of Mycobacterium tuberculosis complex isolates to anti-tuberculosis drugs for Yukon, 2004 to 2014
  Reporting year
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
n % n % n % n % n % n % n % n % n % n % n %

Abbreviations: EMB=ethambutol; INH=isoniazid; PZA=pyrazinamide; RMP=rifampin.

Table 17 Footnotes

Table 17 Footnote 1

Routine testing for PZA not conducted for Yukon.

Return to Table 17 footnote * referrer

Isolates tested for resistance to INH, RMP & EMBTable 17 Footnote * 3 100.0 2 100.0 2 100.0 2 100.0 7 100.0 3 100.0 5 100.0 2 100.0 1 100.0 1 100.0 4 100.0
Isolates susceptible to all first-line TB drugs 3 100.0 2 100.0 2 100.0 2 100.0 7 100.0 3 100.0 5 100.0 2 100.0 1 100.0 1 100.0 4 100.0
Table 18: Multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis isolates by province/territory of origin, 2014
    Originating province
Canada N.L. P.E.I. N.S. N.B. Que. Ont. Man. Sask. Alta. B.C. Y.T. N.W.T Nvt.

Abbreviations: Alta.= Alberta; B.C.= British Columbia; Man.= Manitoba; N.B.= New Brunswick; N.L.= Newfoundland and Labrador; N.S.= Nova Scotia; Nvt.= Nunavut; N.W.T.= Northwest Territories; Ont.= Ontario; P.E.I.= Prince Edward Island; Que.= Quebec; Sask.= Saskatchewan; Y.T.= Yukon.

Table 18 Footnotes

Table 18 Footnote 1

Multidrug-resistant TB is TB that is resistant to isoniazid and rifampin, but does not meet the definition of extensively drug-resistant TB.

Return to Table 18 footnote * referrer

Table 18 Footnote 2

Extensively drug-resistant TB is TB that is resistant to isoniazid and rifampin, any fluoroquinolone and at least one of three injectable second–line drugs (amikacin, capreomycin and kanamycin).

Return to Table 18 footnote referrer

Total Number  of MTBC isolates tested 1,376 6 2 8 6 186 457 125 63 181 270 4 2 66
Multidrug-resistant TBTable 18 Footnote *
Isoniazid & rifampin 10 0 0 0 0 1 3 0 0 2 4 0 0 0
Isoniazid & rifampin & ethambutol 3 0 0 0 0 0 1 0 0 0 2 0 0 0
Isoniazid & rifampin & pyrazinamide  2 0 0 0 0 1 1 0 0 0 0 0 0 0
Isoniazid & rifampin & pyrazinamide & ethambutol 3 0 0 0 0 0 1 0 0 2 0 0 0 0
Total 18 0 0 0 0 2 6 0 0 4 6 0 0 0
Extensively drug-resistant TBTable 18 Footnote
Isoniazid & rifampin & pyrazinamide  & ethambutol & streptomycin & kanamycin & ofloxacin & moxifloxacin & rifabutin  1 0 0 0 0 0 1 0 0 0 0 0 0 0
Total 1 0 0 0 0 0 1 0 0 0 0 0 0 0
Table 19: Provincial/territorial breakdown by any resistance, multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis in Canada, 2004 to 2014
Originating province Total number  of reported MTBC isolates Resistant to one or more first line drugs Multidrug-resistant TBTable 19 Footnote * Extensively drug-resistant TBTable 19 Footnote
Number  Percent (%) Number   Percent (%) Number   Percent (%)

Table 19 Footnotes

Table 19 Footnote 1

Multidrug-resistant TB is TB that is resistant to isoniazid and rifampin, but does not meet the definition of extensively drug-resistant TB

Return to Table 19 footnote * referrer

Table 19 Footnote 2

Extensively drug-resistant TB is TB that is resistant to isoniazid and rifampin, any fluoroquinolone and at least one of three injectable second–line drugs (amikacin, capreomycin and kanamycin).

Return to Table 19 footnote referrer

Ontario 5,688 633 11.1 96 1.7 5 0.1
British Columbia 2,611 255 9.8 23 0.9 0 0.0
Quebec 2,217 226 10.2 19 0.9 1 0.0
Alberta 1,479 145 9.8 24 1.6 0 0.0
Manitoba 1,247 70 5.6 4 0.3 1 0.1
Saskatchewan 710 29 4.1 2 0.3 0 0.0
Nunavut 515 5 1.0 0 0.0 0 0.0
Newfoundland and Labrador 81 1 1.2 0 0.0 0 0.0
Nova Scotia 80 8 10.0 0 0.0 0 0.0
Northwest Territories 80 3 3.8 0 0.0 0 0.0
New Brunswick 64 6 9.4 0 0.0 0 0.0
Yukon 32 0 0.0 0 0.0 0 0.0
Prince Edward Island 9 1 11.1 0 0.0 0 0.0
Canada 14,813 1,382 9.3 168 1.1 7 <0.1
Table 20: Tuberculosis drug resistance by sex and age group in Canada, 2014
Age group and sex Isolates reported Resistant to one or more first line drugs Multidrug-resistantTable 20 Footnote * Extensively drug-resistantTable 20 Footnote
Number  Percent (%) Number  Percent (%) Number  Percent (%) Number  Percent (%)

Table 20 Footnotes

Table 20 Footnote 1

Multidrug-resistant TB is TB that is resistant to isoniazid and rifampin, but does not meet the definition of extensively drug-resistant TB.

Return to Table 19 footnote * referrer

Table 20 Footnote 2

Extensively drug-resistant TB is TB that is resistant to isoniazid and rifampin, any fluoroquinolone and at least one of three injectable second–line drugs (amikacin, capreomycin and kanamycin).

Return to Table 20 footnote referrer

0 to 4 Male 8 0.6 0 0.0 0 0.0 0 0.0
Female 4 0.3 1 0.8 1 5.6 0 0.0
Unknown 0 0.0 0 0.0 0 0.0 0 0.0
Total 12 0.9 1 0.8 1 5.6 0 0.0
5 to 14 Male 12 0.9 1 0.8 0 0.0 0 0.0
Female 10 0.7 0 0.0 0 0.0 0 0.0
Unknown 0 0.0 0 0.0 0 0.0 0 0.0
Total 22 1.6 1 0.8 0 0.0 0 0.0
15 to 24 Male 93 6.8 4 3.1 1 5.6 0 0.0
Female 81 5.9 9 6.9 1 5.6 0 0.0
Unknown 0 0.0 0 0.0 0 0.0 0 0.0
Total 174 12.6 13 9.9 2 11.1 0 0.0
25 to 34 Male 116 8.4 9 6.9 3 16.7 0 0.0
Female 134 9.7 21 16.0 2 11.1 1 100.0
Unknown 0 0.0 0 0.0 0 0.0 0 0.0
Total 250 18.2 30 22.9 5 27.8 1 100.0
35 to 44 Male 103 7.5 11 8.4 0 0.0 0 0.0
Female 113 8.2 16 12.2 3 16.7 0 0.0
Unknown 0 0.0 0 0.0 0 0.0 0 0.0
Total 216 15.7 27 20.6 3 16.7 0 0.0
45 to 54 Male 120 8.7 9 6.9 2 11.1 0 0.0
Female 70 5.1 7 5.3 1 5.6 0 0.0
Unknown 0 0.0 0 0.0 0 0.0 0 0.0
Total 190 13.8 16 12.2 3 16.7 0 0.0
55 to 64 Male 110 8.0 12 9.2 1 5.6 0 0.0
Female 49 3.6 5 3.8 0 0.0 0 0.0
Unknown 0 0.0 0 0.0 0 0.0 0 0.0
Total 159 11.6 17 13.0 1 5.6 0 0.0
65 to 74 Male 90 6.5 12 9.2 1 5.6 0 0.0
Female 50 3.6 4 3.1 0 0.0 0 0.0
Unknown 1 0.1 0 0.0 0 0.0 0 0.0
Total 141 10.2 16 12.2 1 5.6 0 0.0
75+ Male 127 9.2 5 3.8 1 5.6 0 0.0
Female 83 6.0 5 3.8 1 5.6 0 0.0
Unknown 1 0.1 0 0.0 0 0.0 0 0.0
Total 211 15.3 10 7.6 2 11.1 0 0.0
Unknown Male 0 0.0 0 0.0 0 0.0 0 0.0
Female 1 0.1 0 0.0 0 0.0 0 0.0
Unknown 0 0.0 0 0.0 0 0.0 0 0.0
Total 1 0.1 0 0.0 0 0.0 0 0.0
Total Male 779 56.6 63 48.1 9 50.0 0 0.0
Female 595 43.2 68 51.9 9 50.0 1 100.0
Unknown 2 0.1 0 0.0 0 0.0 0 0.0
Total 1,376 100.0 131 100.0 18 100.0 1 100.0

References

Footnotes

Footnote 1

Christianson S, Jamieson F, Sharma M, Wolfe J. Appendix D: Tuberculosis and mycobacteriology laboratory standards. In: Menzies R and Wong T. (eds). 2013. Canadian Tuberculosis Standards, 7th Edition. Canadian Thoracic Society, Canadian Lung Association, Public Health Agency of Canada.

Return to footnote 1 referrer

Footnote 2

World Health Organization. Definitions and reporting framework for tuberculosis – 2013 revision. Geneva: WHO Press; 2013 Available from: http://apps.who.int/iris/bitstream/10665/79199/1/9789241505345_eng.pdf.

Return to footnote 2 referrer

Footnote 3

Woods GL, Brown-Elliott BA, Conville PS, et al. Susceptibility testing of mycobacteria, nocardiae, and other aerobic actinomycetes; Approved standard. 2nd ed. Wayne, PA: Clinical and Laboratory Standards Institute; 2011.

Return to footnote 3 referrer

Footnote 4

Sharma M, Thibert L, Chedore P, et al. Canadian multicentre laboratory study for standardized second-line antimicrobial susceptibility testing of mycobacterium tuberculosis. J Clin Microbiol. 2011;49(12):4112-6.

Return to footnote 4 referrer

Footnote 5

Public Health Agency of Canada. Directive for the collection, use and dissemination of information relating to public health. Unpublished document. Ottawa, ON: 2013.

Return to footnote 5 referrer

Footnote 6

World Health Organization. Global tuberculosis report 2013. Geneva: WHO Press; 2013. Available from: http://apps.who.int/iris/bitstream/10665/91355/1/9789241564656_eng.pdf.

Return to footnote 6 referrer

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