Authors: Aguiar, F.¹; Vieira, M.A.¹; Staviack, A.¹; Buarque, C.¹; Marsico, A.¹; Fonseca, L.¹; Chaisson, R.²; Kristski, A.¹; Werneck, G.³; Mello, F.¹

Source: The International Journal of Tuberculosis and Lung Disease, Volume 13, Number 1, January 2009 , pp. 54-61(8)

Publisher: International Union Against Tuberculosis and Lung Disease

Abstract:

SETTING: A reference hospital for tuberculosis (TB) and human immunodeficiency virus/acquired immune-deficiency syndrome (HIV/AIDS) with a TB control programme in Rio de Janeiro, Brazil.

OBJECTIVE: To estimate the prevalence of resistance to anti-tuberculosis drugs and to identify associated factors.

DESIGN: In a cross-sectional study, clinical and laboratory data were collected retrospectively from 2001 to 2005. Patients with isolation of Mycobacterium tuberculosis and available drug susceptibility tests were considered eligible. Data on demographic characteristics, risk factors for resistance, HIV serology and past TB history were collected and analysed by χ² Mann-Whitney test and Poisson regression.

RESULTS: We analysed 350 treatments, of which 62 were for patients with previous TB. HIV status was positive in 31.2% of cases. Resistance was found in 15.7% and multidrug resistance (MDR) in 4.3% of cases. Previous treatment (P < 0.001) and relapse within 2 years were associated with resistance (P < 0.03). Pulmonary cavities were associated with MDR (P < 0.001). Homelessness was associated with any resistance in newly diagnosed patients (P < 0.01). Working in a hospital was not associated with resistance.

CONCLUSION: Suspicion of drug-resistant disease is necessary in patients with a history of previous TB in hospitals in Rio de Janeiro. The implementation of an effective hospital TB control programme can prevent transmission even in high TB prevalence settings.

Keywords: drug resistance; tuberculosis chemotherapy; hospital infection control programme; multidrug-resistant TB; transmissible disease control

Document Type: Regular paper

Affiliations: 1: Instituto de Doenças do Tórax (IDT)/Clementino Fraga Filho Hospital (CFFH), Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil 2: Department of Pulmonary Medicine, Center for Tuberculosis Research, Johns Hopkins University, Baltimore, Maryland, USA 3: Instituto de Estudos em Saúde Coletiva, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil; and Departamento de Epidemiologia, Instituto de Medicina, Social State University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil

Publication date: 2009-01-01

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• The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

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