Epidemiology and clinical consequences of drug-resistant tuberculosis in a Guatemalan hospital

Edward M. Harrow, Josefa M. Rangel, J. Manuel Arriega, Isaac Cohen, Marta Ileana De Leon Régil Ruíz, Kathryn DeRiemer, Peter M. Small

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13 Scopus citations

Abstract

Study objective: To determine the epidemiology and clinical consequences of drug-resistant TB in Guatemala. Design: A prospective study conducted for 12 months. Setting: A thoracic referral hospital in western Guatemala. Patients: Three hundred and seventy-six patients with confirmed TB. Results: Of 376 confirmed cases, 335 (89%) were culture-positive. Tests of drug sensitivities to four first-line antituberculous drugs were performed in 172 (51%) of the culture-positive cases. Fifty-one patients (30%) were resistant to at least one antimicrobial agent, and 26 (15%) were resistant to at least two drugs. In a multivariate model of clinically available patient characteristics, only cavitary disease (odds ratio=2.1; 95% confidence interval, 1.1-6.6) and a history of taking anti-TB medication for >2 weeks (OR=3.0; 95% CI, 1.5-10.3) were independent predictors of resistance to two or more anti-TB agents. Resistance to two or more anti-TB drugs was the single independent predictor of treatment failure (OR=6.4; 95% CI, 2.3- 17.8). Twenty-four of 172 patients (14%) who denied having received prior anti-TB therapy were infected with resistant organisms, suggesting ongoing transmission of drug-resistant strains. Although 84% (69 of 82 cases) of patients with fully susceptible organisms and 89% (17 of 19 cases) with singly resistant organisms were cured, only 45% of patients (10 of 22 cases) infected with organisms resistant to two or more agents were successfully treated. Conclusions: At this sentinel site for complicated TB, a substantial subset of cases who are infected with drug-resistant bacteria cannot be easily identified or treated.

Original languageEnglish (US)
Pages (from-to)1452-1458
Number of pages7
JournalChest
Volume113
Issue number6
StatePublished - 1998

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Keywords

  • Drug resistance
  • Epidemiology
  • Guatemala
  • Therapy
  • Tuberculosis

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Harrow, E. M., Rangel, J. M., Arriega, J. M., Cohen, I., De Leon Régil Ruíz, M. I., DeRiemer, K., & Small, P. M. (1998). Epidemiology and clinical consequences of drug-resistant tuberculosis in a Guatemalan hospital. Chest, 113(6), 1452-1458.