[Present trends of drug-resistant tuberculosis and how to manage it by mycobacterial laboratories].

Global, domestic, and local trends of drug-resistant tuberculosis and how to manage increase in the resistance by mycobacterial laboratories were discussed based on literatures and our own data. At first, how to make drug-resistant tuberculosis was explained. Genetic drug-resistant bacteria were emerged spontaneously by mutation of the genome and were selected by inadequate treatment(mono-therapy or functional mono-therapy): acquired drug resistance(single, and then multi-drug resistance). In a mean time, some people were infected with the drug-resistant bacteria from the beginning and a part of them developed active disease: primary drug resistance (single or multi-drug resistance). Estonia, Latvia, Iran, and some part of Russia, China, and India were reported to be the most endemic region of drug resistant and multi-drug resistant tuberculosis in the world. The rate of primary resistance in Japan was as high as the median of the world, but the rate of acquired resistance was almost twice of the median. Since delays in reporting of the drug resistance from the laboratory seemed one of reasons for the inadequate treatment, drug susceptibility testing should be more rapid than usual, by using liquid media such as BACTEC MGIT 960 system, or gene analysis.