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      Resistencia a drogas antituberculosas en Caracas, Venezuela; 2001-2006 Translated title: Antituberculosis drug resistance in Caracas, Venezuela; 2001-2006

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          Abstract

          Para establecer la sensibilidad de las cepas de Mycobac-terium tuberculosis aisladas en Caracas, entre 2001 y 2006, fueron probadas utilizando el método colorimétrico para determinar las Concentraciones Inhibitorias Mínimas (CIM). De las 324 cepas, 46 (14,2%) mostraron resistencia a una o más drogas. Encontramos resistencia de alto nivel (CIM 8 µg/ml) y bajo nivel (CIM 1-4 µg/ml) a Estreptomicina en 6 (1,8%) y 25 (7,7%) de las cepas, respectivamente. Se encontró resistencia a Isoniacida de bajo nivel (MIC 0,125 - 0,5 µg/ml) en 8 (2,5%) y de alto nivel (MIC 1,0 µg/ml) en 15 (4,6%) de las cepas estudiadas. Hallamos 13 (4,0%) cepas resistentes a Rifampicina (RIF) (5 µg/ml) y 11 (3,4%) a Etambutol (10 µg/ml). De los 17 (5,2%) aislamientos resistentes a dos o más drogas, 12 (3,7%) fueron resistentes a INH y RIF (definido como multirresistencia, MDR). De las 12 cepas MDR, 11 fueron aisladas a partir de esputo y una de líquido pleural. Este estudio muestra un incremento en la prevalencia de la resistencia a las drogas antituberculosas en Caracas, especialmente las cepas MDR. Este aumento apunta hacia la necesidad de una encuesta na-cional, para evaluar el panorama real de la resistencia.

          Translated abstract

          To asses drug susceptibility of Mycobacterium tuberculosis strains isolated from 2001 to 2006 in Caracas. Available strains were tested using colorimetric method to determine the Minimal Inhibitory Concentrations (MIC). Of 324 strains, 46 (14,2%) showed resistance to one or more drugs. High-resistance (8 µg/ml) and low-resistance (1-4 µg/ml) to Strep omycint was found in 6 (1,8%) and 25 (7,7%) strains, respectively. Isoniazid (INH) low-resistance (MIC 0.125 - 0.5 µg/ml) were found in 8 (2,5%) and high-resistant (MIC at 1.0 µg/ml) in 15 (4,6%), Rifampicin resistance (RMP) (5 µg/ml) in 13 (4%), and Ethambutol resistance (10 µg/ml) in 11 (3,4%) of the strains. Of the 17 (5,2%) isolates resistant to two or more drugs, 12 (3,7%) were resistant to INH and RMP (defined as multidrug resistance, MDR). Of these 12 MDR strains, 11 were isolated from sputum and one from pleu ral fluid. This study shows an increased prevalence of resistance to anti-tuberculosis drugs in Caracas, especially the prevalence of MDR strains, raises an urgent need of a proper nationwide survey to evaluate the true picture of resistance.

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          Treatment of 171 patients with pulmonary tuberculosis resistant to isoniazid and rifampin.

          The frequency of infection with multidrug-resistant Mycobacterium tuberculosis is increasing. We reviewed the clinical courses of 171 patients with pulmonary disease due to M. tuberculosis resistant to rifampin and isoniazid who were referred to our hospital between 1973 and 1983. The patients' records were analyzed retrospectively. Their regimens were selected individually and preferably included three medications that they had not been given previously and to which the strain was fully susceptible. The 171 patients (median age, 46 years) had previously received a median of six drugs and shed bacilli that were resistant to a median of six drugs. Thus, their regimens were frequently not optimal. Of 134 patients with sufficient follow-up data, 87 (65 percent) responded to chemotherapy (as indicated by negative sputum cultures for at least three consecutive months); 47 patients (35 percent) had no response, as shown by continually positive cultures. The median stay in the hospital was more than seven months. In a multivariate analysis, an unfavorable response was significantly associated with a greater number of drugs received before the current course of therapy (odds ratio, 4.0; 95 percent confidence interval, 1.6 to 9.9; P < 0.001) and with male sex (odds ratio, 2.5; 95 percent confidence interval, 1.1 to 6.2; P < 0.03). Twelve of the patients with responses subsequently had relapses. The overall response rate was 56 percent over a mean period of 51 months. Of the 171 patients, 63 (37 percent) died, and 37 of these deaths were attributed to tuberculosis. For patients with pulmonary tuberculosis that is resistant to rifampin and isoniazid, even the best available treatment is often unsuccessful. Only about half of such patients eventually have negative sputum cultures despite carefully selected regimens administered for extended periods. Failure to control this resistant infection is associated with high mortality and ominous implications for the public health.
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            The emergence of drug-resistant tuberculosis in New York City.

            In the past decade the incidence of tuberculosis has increased nationwide and more than doubled in New York City, where there have been recent nosocomial outbreaks of multidrug-resistant tuberculosis. We collected information on every patient in New York City with a positive culture for Mycobacterium tuberculosis during April 1991. Drug-susceptibility testing was performed at the Centers for Disease Control and Prevention. Of the 518 patients with positive cultures, 466 (90 percent) had isolates available for testing. Overall, 33 percent of these patients had isolates resistant to one or more antituberculosis drugs, 26 percent had isolates resistant to at least isoniazid, and 19 percent had isolates resistant to both isoniazid and rifampin. Of the 239 patients who had received antituberculosis therapy, 44 percent had isolates resistant to one or more drugs and 30 percent had isolates resistant to both isoniazid and rifampin. Among the patients who had never been treated, the proportion with resistance to one or more drugs increased from 10 percent in 1982 through 1984 to 23 percent in 1991 (P = 0.003). Patients who had never been treated and who were infected with the human immunodeficiency virus (HIV) or reported injection-drug use were more likely to have resistant isolates. Among patients with the acquired immunodeficiency syndrome, those with resistant isolates were more likely to die during follow-up through January 1992 (80 percent vs. 47 percent, P = 0.02). A history of antituberculosis therapy was the strongest predictor of the presence of resistant organisms (odds ratio, 2.7; P < 0.001). There has been a marked increase in drug-resistant tuberculosis in New York City. Previously treated patients, those infected with HIV, and injection-drug users are at increased risk for drug resistance. Measures to control and prevent drug-resistant tuberculosis are urgently needed.
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              Global tuberculosis control: surveillance, planning, financing

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                Author and article information

                Journal
                inhrr
                Revista del Instituto Nacional de Higiene Rafael Rangel
                INHRR
                Instituto Nacional de Higiene Rafael Rangel (Caracas, DF, Venezuela )
                0798-0477
                December 2010
                : 41
                : 2
                : 52-62
                Affiliations
                [02] orgnameLaboratorio de Tuberculosis, Instituto de Biomedicina
                [04] orgnameHospital General del Este Dr. Domingo Luciani
                [03] orgnameUniversidad Simón Bolívar
                [05] orgnameHospital General de Niños Dr. J.M. de los Ríos
                [01] Caracas orgnameInstituto Nacional de Higiene Rafael Rangel orgdiv1Laboratorio de Diagnósticos Especiales, Departamento de Bacteriología Venezuela sfernandez@ 123456inhrr.gov.ve
                [07] orgnameLaboratorio de Bacteriología, Clínica Santa Sofía
                [06] orgnameHospital de Clínicas Caracas
                Article
                S0798-04772010000200008 S0798-0477(10)04100208
                71650c6c-d4a4-47ea-80d6-d0dd823d5439

                http://creativecommons.org/licenses/by/4.0/

                History
                : 16 March 2009
                : 24 February 2010
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 27, Pages: 11
                Product

                SciELO Venezuela

                Categories
                Artículos Originales

                isoniazid,Antibióticos,resistencia a antibióticos,resistencia a múltiples drogas,tuberculosis,isoniacida,estrep omicina,trifampicina,etambutol,Antibiotics,antibiotic resistance,multi drug resistance,streptomycin,rifampicin,ethambutol

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