Comment on “Mycobacteria Presence and Anti-Tuberculosis Drug Resistance Profile in Duzce Region: 18 Years of Experience”: An Interpretation of Regional Resistance Patterns and Temporal Fluctuations in Light of National Trends

This letter to the editor analyzes the study by Akbaş et al. on tuberculosis drug resistance in the Düzce region by comparing its findings with Turkey's national data. The analysis reveals that while the overall resistance rate in Düzce (23.5%) is significantly higher than the national average (~16.5%), the resistance dynamics show unique regional characteristics. Notably, the rates of mono-resistance to Isoniazid (8.9%) and Ethambutol (2.9%) in Düzce are substantially higher than the national averages (~5.3% and ~0.6%, respectively). Furthermore, temporal analysis highlights dramatic fluctuations and peaks in resistance in Düzce (e.g., 35.8% H-resistance in 2016), which are not reflected in the stable national trends. This comparison underscores the critical importance of local surveillance in identifying regional resistance hotspots and proves that national averages alone may mask significant local public health threats.