Comparative analysis of multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis – Epidemiology and predictive factors
Análise comparativa entre tuberculose multirresistente e tuberculose extensivamente resistente – Epidemiologia e factores preditivos
Ana Sofia Vilariça1,
, Carlos Gomes2, Jaime Pina3
Corresponding author
anasofia.vilarica@gmail.com
Serviço de Pneumologia III Hospital de Pulido Valente, Centro Hospitalar Lisboa Norte, Lisboa Alameda das Linhas de Torres, 117 1769-001Lisboa.
Serviço de Pneumologia III Hospital de Pulido Valente, Centro Hospitalar Lisboa Norte, Lisboa Alameda das Linhas de Torres, 117 1769-001Lisboa.
1 Interna do Internato Complementar de Pneumologia / Pulmonology resident, Pulido Valente Hospital, Lisbon
2 Assistente Hospitalar Graduado de Pneumologia / Pulmonology consultant and specialist, Pulido Valente Hospital, Lisbon
3 Chefe de Serviço Hospitalar de Pneumologia e Director do Serviço de Pneumologia III do Hospital de Pulido Valente, Lisboa / Head, Hospital Pulmonology Service and Director, Hospital Pulmonology Service III, Pulido Valente Hospital, Lisbon
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It was classified by WHO as a serious threat to tuberculosis (TB) control, with world-wide consequences, taking on the proportions of a real pandemic in some regions.</p> <span class="elsevierStyleSectionTitle">Aim</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">To compare patients with XDR-TB <span class="elsevierStyleItalic">versus</span> other MDR-TB profiles with regard to epidemiological and demographic characteristics, aetiopathogenic factors and inhospital outcomes.</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Patients admitted to Pulido Valente Hospital (Pulmonology Service III) in the period ranging from April 1999 to June 2007 with MDR-TB diagnosis microbiologically confirmed. The following variables were evaluated: gender, age, race, forms of TB presentation, treatment groups, resistance profile, immigrant status, number and duration of previous treatments, WHO classification, HIV co-infection, alcoholism and/or drug addiction, average length of hospital stay and inhospital mortality.</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Statistical analysis was performed using the SPSS (Statistical Package for the Social Sciences), version 15.0. In categorical variables, the statistical differences between groups were evaluated by the Chisquare test and numeric variables using the T-test. Logistical regression analysis was used to build the predictive model of XDR-TB existence (dependent variable), which included the following independent variables: WHO classification, HIV co-infection, immigrant status, alcoholism and/or drug addiction and number and duration of previous treatments.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">We recorded 132 patients with MDR-TB, of which 69 (52.3%) were XDR-TB. Statistically significant differences were observed in the following variables: race (black race was associated with XDRTB in 74% of cases <span class="elsevierStyleItalic">versus</span> 46% of the Caucasian race); WHO classification (patients with retreatment for therapeutic failure, stopping treatment or relapse were 69.5% of XDR-TB cases <span class="elsevierStyleItalic">versus</span> 44.5% of Not XDR-TB cases; average duration of previous treatments (4.2 months for XDR-TB cases <span class="elsevierStyleItalic">versus</span> 2.8 months for Not XDR-TB cases); HIV co-infection (patients with HIV co-infection constituted 65.2% of XDR-TB cases <span class="elsevierStyleItalic">versus</span> 42.9% of Not XDR-TB cases), mortality (33.3% in patients with XDR-TB <span class="elsevierStyleItalic">versus</span> 14.3% in Not XDR-TB patients).</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">The variables with predictive value for the diagnosis of XDR-TB vs. Not XDR-TB were presence of HIV co-infection (odds ratio [OR] for XDRTB 2.5; 95% confidence interval [CI], 1.24–5.05) and increased average duration of previous treatments ([OR] for XDR-TB 1.2; 95% [CI], 1.11–2.30).</p>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<span class="elsevierStyleSectionTitle">Introdução</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A tuberculose extensivamente resistente (TBXDR) define-se como uma forma de tuberculose multirresistente (TBMR) com resistências adicionais às fluoroquinolonas e, pelo menos, a um dos antibacilares injectáveis seguintes: amicacina, canamicina e capreomicina. Foi classificada pela OMS como uma ameaça séria ao controlo da tuberculose, com consequências à escala mundial, assumindo os contornos de uma autêntica pandemia em algumas regiões do globo.</p> <span class="elsevierStyleSectionTitle">Objectivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Comparar os doentes com TBXDR <span class="elsevierStyleItalic">versus</span> outros perfis de TBMR no que diz respeito às características demográficas e epidemiológicas, factores etiopatogénicos e evolução no internamento.</p> <span class="elsevierStyleSectionTitle">Material e métodos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Doentes internados no Serviço de Pneumologia III do Hospital de Pulido Valente no período compreendido entre Abril de 1999 e Junho de 2007, com o diagnóstico de TBMR microbiologicamente confirmado. Foram analisadas as seguintes variáveis: sexo, distribuição etária, raça, formas de apresentação da TB, grupos de tratamento, perfil de resistência aos antibacilares, estatuto de imigrante, número e duração de tratamentos anteriores, classificação OMS, co-infecção VIH, alcoolismo e/ou toxicodependência, demora média do internamento e mortalidade intra-hospitalar. A análise estatística realizou-se no programa SPSS (Statistical Package for the Social Sciences), versão 15.0. Nas variáveis categoriais, as diferenças estatísticas entre os grupos foram avaliadas através do teste qui-quadrado e as variáveis numéricas através do teste t. Para a construção do modelo preditivo da presença de TBXDR (variável dependente) foi utilizada a análise de regressão logística, tendo sido incluídas as seguintes variáveis independentes: classificação OMS, coinfecção VIH, estatuto de imigrante, alcoolismo e/ou toxicodependência e número e duração de tratamentos anteriores.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Foram contabilizados 132 doentes com TBMR, dos quais 69 (52,3%) eram TBXDR. Observaram-se diferenças estatisticamente significativas nas seguintes variáveis: raça (a raça negra esteve associada a TBXDR em 74% dos casos <span class="elsevierStyleItalic">versus</span> 46% da raça caucasiana); classificação OMS (doentes com retratamento por insucesso terapêutico, interrupção do tratamento ou recidiva constituíram 69,5% dos casos de TBXDR <span class="elsevierStyleItalic">versus</span> 44,5% dos casos não TBXDR); duração média dos tratamentos anteriores (4,2 meses para os casos de TBXDR <span class="elsevierStyleItalic">versus</span> 2,8 meses para os casos não TBXDR); coinfecção VIH/SIDA (doentes com coinfecção VIH constituíram 65,2% dos casos de TB XDR <span class="elsevierStyleItalic">versus</span> 42,9% dos casos não TBXDR) e mortalidade (33,3% nos doentes com TBXDR <span class="elsevierStyleItalic">versus</span> 14,3% nos doentes não TBXDR).</p> <span class="elsevierStyleSectionTitle">Conclusões</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">As variáveis com valor preditivo para o diagnóstico de TBXDR <span class="elsevierStyleItalic">versus</span> não TBXDR foram: presença de infecção VIH (risco relativo [RR] para TBXDR de 2,5; intervalo de confiança [IC], 1,24–5,05); maior duração média dos tratamentos anteriores ([RR] para TB XDR de 1,2; [IC], 1,11–2,30).</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography/Bibliografia" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:13 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 5 | 11 |
| 2024 October | 24 | 40 | 64 |
| 2024 September | 30 | 22 | 52 |
| 2024 August | 39 | 30 | 69 |
| 2024 July | 23 | 33 | 56 |
| 2024 June | 25 | 19 | 44 |
| 2024 May | 33 | 31 | 64 |
| 2024 April | 20 | 24 | 44 |
| 2024 March | 23 | 22 | 45 |
| 2024 February | 22 | 25 | 47 |
| 2024 January | 14 | 21 | 35 |
| 2023 December | 14 | 29 | 43 |
| 2023 November | 20 | 30 | 50 |
| 2023 October | 15 | 24 | 39 |
| 2023 September | 13 | 35 | 48 |
| 2023 August | 22 | 20 | 42 |
| 2023 July | 23 | 34 | 57 |
| 2023 June | 13 | 22 | 35 |
| 2023 May | 22 | 24 | 46 |
| 2023 April | 10 | 9 | 19 |
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