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      Incidencia de la resistencia a drogas en tuberculosis y su asociación a comorbilidades en pacientes tratados en un hospital universitario

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          Abstract

          La tuberculosis constituye un problema de salud pública con mayor incidencia en países pobres y presenta dos aspectos a considerar. Las comorbilidades que se comportan como factores de riesgo predisponentes de enfermedad tuberculosa, que pueden complicar su evolución y tratamiento. Por otra parte la resistencia a drogas antituberculosas de primera línea constituye una amenaza para el control de la TB. Con el objetivo de determinar la incidencia de las entidades comórbidas en pacientes con diagnóstico de tuberculosis y la frecuencia de casos con resistencia a drogas se incluyeron en el estudio los pacientes mayores de 16 años con tuberculosis confirmada en el Hospital de Clínicas "San José de San Martín". Se utilizó el programa SSPS 15 para el análisis estadístico. Entre abril de 1997 y marzo del 2010, 687 pacientes fueron tratados por TB confirmada. Las comorbilidades más frecuentes fueron: tabaquismo 14%; enolismo 4.8%; neoplasias 3.3%; EPOC y asma 5.6%; enfermedades hematológicas 2%; enfermedades autoinmunes 3.3%; diabetes 3%; VIH 6.5%; IRC 1.2%. El tabaquismo se presentó más frecuentemente asociado a la forma pulmonar estricta (p = 0.079), a diferencia de las enfermedades autoinmunes y hematológicas que se presentaron como formas miliares (p = 0.001) y VIH como formas mixtas (p = 0.002). La resistencia se presentó más frecuentemente en enfermedades autoinmunes (4%) y HIV (2%), sin valor significativo (p = 0.779). Del total de los pacientes, se detectó un n = 47 (6.8%) con algún tipo de resistencia a las drogas. En los últimos 4 años se detectaron 2 casos de XDR. No se encontró asociación significativa entre los diferentes tipos de resistencias con la presencia de comorbilidades. Sólo se registró un óbito en un paciente con XDR. La presencia de tratamiento previo (p = 0.001) y las formas bacilíferas (p = 0.016) fueron los factores asociados a un incremento de la resistencia.

          Translated abstract

          Tuberculosis is a public health problem with a higher incidence in poor countries. There are two aspects to consider: co-morbidities which are risk factors for tuberculosis, complicating its evolution and treatment, and resistance to first line drugs which is a threat to tuberculosis control. The objective of the paper was to identify the co-morbidities and the frequency of drug resistance in tuberculosis patients. The study included patients older than 16 years of age with diagnosis of tuberculosis at the Hospital de Clinicas San Jose de San Martin in Buenos Aires. The SSPS 15 program was used for the statistical analysis. From April 1997 to March 2010, 687 patients were treated for confirmed tuberculosis. The most frequent co-morbidities were: tobacco smoking habit 14%; alcoholism 4.8%; cancer 3.3%; COPD and asthma 5.6%; blood diseases 2%; autoimmune diseases 3.3%; diabetes 3%; HIV infection 6.5%; IRC 1.2%. The tobacco smoking habit was more frequently associated to pulmonary tuberculosis (p = 0.079), instead the autoimmune and blood diseases were mostly associated to miliary tuberculosis (p = 0.001) and the HIV infection to tuberculosis in several organs (p = 0.002). Drug resistance was more frequent when autoimmune diseases (4%) and HIV infection (2%) were present, but without reaching statistical significance (p = 0.779). Resistance to at least one drug was present in 47 patients (6.8%). In the last 4 years, 2 cases of extremely drug resistant tuberculosis were detected. There was no significant association between the type of drug resistance and the co-morbidities. Only one death was registered in a patient with extremely drug resistant tuberculosis. Previous treatment (p = 0.001) and sputum positive tuberculosis (p = 0.016) were factors associated to increased drug resistance.

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          Most cited references15

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          Targeted tuberculin testing and treatment of latent tuberculosis inflection

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            Increased incidence of multidrug-resistant tuberculosis in diabetic patients on the Bellevue Chest Service, 1987 to 1997.

            To investigate the characteristics of tuberculosis infection in diabetic patients at Bellevue Hospital. We conducted a case-control study retrospectively reviewing the records of patients at Bellevue Hospital Center from 1987 to 1997 with a discharge diagnosis of tuberculosis and diabetes mellitus. Bellevue Hospital Center is a 1,200-bed, inner-city municipal hospital located in the Lower East Side of New York City. Fifty-three identified patients had verified tuberculosis infection and diabetes; of these, 50 charts were available for review. One hundred five control cases were selected from nondiabetic patients with a discharge diagnosis of tuberculosis during the same time period. Thirty-six percent (18 cases) of the patients with diabetes and tuberculosis had multidrug-resistant tuberculosis (MDR-TB) compared to only 10% (10 cases) in the control group (p < 0.01) Controlling for homelessness, HIV status, and directly observed therapy, the relative risk of MDR-TB was calculated to be 8.6 (confidence interval, 3.1 to 23.6) in the diabetic group compared to the control group. There was a significant association between diabetes and MDR-TB. Diabetes continues to be a risk factor for tuberculosis and was associated with MDR-TB in our patients.
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              Global tuberculosis control: epidemiology, strategy, financing

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                Author and article information

                Journal
                ramer
                Revista americana de medicina respiratoria
                Rev. am. med. respir.
                Asociación Argentina de Medicina Respiratoria (CABA, , Argentina )
                1852-236X
                June 2013
                : 13
                : 2
                : 64-70
                Affiliations
                [01] orgnameHospital de Clínicas José de San Martín orgdiv1División Neumonología
                Article
                S1852-236X2013000200004 S1852-236X(13)01300200004
                3ef18d74-4dcb-4823-9c34-2c5cfbc4abda

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 18 March 2013
                : 10 May 2013
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 13, Pages: 7
                Product

                SciELO Argentina

                Categories
                Articulos originales

                Resistance,Tuberculosis,Comorbilidades,Resistencia,Co-morbidities

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