Multi-drug-resistant tuberculosis in a Department of Infectious Diseases.
Autor(a) principal: | |
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Data de Publicação: | 2004 |
Outros Autores: | , , |
Tipo de documento: | Artigo |
Idioma: | por |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/1653 |
Resumo: | In Western Europe, Portugal has the highest incidence of tuberculosis (TB) as well as HIV infection. At the Department of Infectious Diseases, Hospital de Santa Maria, Lisbon, we have observed a steady increase in cases of drug resistant (DR) and multi-drug resistant (MDR) TB over the last few years. To identify the determinants of drug- resistant tuberculosis, clinical notes from all patients admitted to the Department of Infectious Diseases from 1995 to 2000, with DR- or MDR-TB were retrospectively reviewed. A total of 212 samples, from 190 patients with tuberculosis were tested for sensitivity to first line anti-TB drugs, using standard methods. Most patients (61%) were intravenous drugs users. Resistance to at least one drug was found in 44 patients (23%); notes were available for review in 39 (36 HIV infected) patients. The rate of DR-TB was 9% (n=16) and that of MDR-TB was 15% (n=28). Almost half of the MDR-TB cases (n=13) showed resistance to four drugs (HRSE). Thirteen patients (69%) were first diagnosed as fully sensitive tuberculosis, during their first admission to the Department; however, later on they developed MDR-TB or DR-TB. Non-compliance with therapy and the intravenous use of drugs were associated with MDR-TB. The large increase in MDR-TB in our Department is of great concern. The clustering of identical resistance patterns suggest transmission of TB from a single source patient that may well have occurred in a nosocomial context. Traditional tuberculosis control measures seem to be insufficient in settings were prevalence of HIV infection and tuberculosis are high. This becomes even more important when the incidence of intravenous substance abuse, and often non-compliance, are predominant factors. Appropriate isolation facilities for all suspected tuberculosis cases as well as rapid diagnostic and drug susceptibility tests will be required to prevent further spread of MDR-TB. |
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Multi-drug-resistant tuberculosis in a Department of Infectious Diseases.Tuberculose multirresistente.In Western Europe, Portugal has the highest incidence of tuberculosis (TB) as well as HIV infection. At the Department of Infectious Diseases, Hospital de Santa Maria, Lisbon, we have observed a steady increase in cases of drug resistant (DR) and multi-drug resistant (MDR) TB over the last few years. To identify the determinants of drug- resistant tuberculosis, clinical notes from all patients admitted to the Department of Infectious Diseases from 1995 to 2000, with DR- or MDR-TB were retrospectively reviewed. A total of 212 samples, from 190 patients with tuberculosis were tested for sensitivity to first line anti-TB drugs, using standard methods. Most patients (61%) were intravenous drugs users. Resistance to at least one drug was found in 44 patients (23%); notes were available for review in 39 (36 HIV infected) patients. The rate of DR-TB was 9% (n=16) and that of MDR-TB was 15% (n=28). Almost half of the MDR-TB cases (n=13) showed resistance to four drugs (HRSE). Thirteen patients (69%) were first diagnosed as fully sensitive tuberculosis, during their first admission to the Department; however, later on they developed MDR-TB or DR-TB. Non-compliance with therapy and the intravenous use of drugs were associated with MDR-TB. The large increase in MDR-TB in our Department is of great concern. The clustering of identical resistance patterns suggest transmission of TB from a single source patient that may well have occurred in a nosocomial context. Traditional tuberculosis control measures seem to be insufficient in settings were prevalence of HIV infection and tuberculosis are high. This becomes even more important when the incidence of intravenous substance abuse, and often non-compliance, are predominant factors. Appropriate isolation facilities for all suspected tuberculosis cases as well as rapid diagnostic and drug susceptibility tests will be required to prevent further spread of MDR-TB.In Western Europe, Portugal has the highest incidence of tuberculosis (TB) as well as HIV infection. At the Department of Infectious Diseases, Hospital de Santa Maria, Lisbon, we have observed a steady increase in cases of drug resistant (DR) and multi-drug resistant (MDR) TB over the last few years. To identify the determinants of drug- resistant tuberculosis, clinical notes from all patients admitted to the Department of Infectious Diseases from 1995 to 2000, with DR- or MDR-TB were retrospectively reviewed. A total of 212 samples, from 190 patients with tuberculosis were tested for sensitivity to first line anti-TB drugs, using standard methods. Most patients (61%) were intravenous drugs users. Resistance to at least one drug was found in 44 patients (23%); notes were available for review in 39 (36 HIV infected) patients. The rate of DR-TB was 9% (n=16) and that of MDR-TB was 15% (n=28). Almost half of the MDR-TB cases (n=13) showed resistance to four drugs (HRSE). Thirteen patients (69%) were first diagnosed as fully sensitive tuberculosis, during their first admission to the Department; however, later on they developed MDR-TB or DR-TB. Non-compliance with therapy and the intravenous use of drugs were associated with MDR-TB. The large increase in MDR-TB in our Department is of great concern. The clustering of identical resistance patterns suggest transmission of TB from a single source patient that may well have occurred in a nosocomial context. Traditional tuberculosis control measures seem to be insufficient in settings were prevalence of HIV infection and tuberculosis are high. This becomes even more important when the incidence of intravenous substance abuse, and often non-compliance, are predominant factors. Appropriate isolation facilities for all suspected tuberculosis cases as well as rapid diagnostic and drug susceptibility tests will be required to prevent further spread of MDR-TB.Ordem dos Médicos2004-04-30info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttps://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/1653oai:ojs.www.actamedicaportuguesa.com:article/1653Acta Médica Portuguesa; Vol. 17 No. 2 (2004): Março-Abril; 157-66Acta Médica Portuguesa; Vol. 17 N.º 2 (2004): Março-Abril; 157-661646-07580870-399Xreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPporhttps://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/1653https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/1653/1234Constant, Carolina ArezFerreira, Pedro BravoValadas, EmíliaAntunes, Franciscoinfo:eu-repo/semantics/openAccess2022-12-20T10:58:28Zoai:ojs.www.actamedicaportuguesa.com:article/1653Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T16:17:18.182923Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Multi-drug-resistant tuberculosis in a Department of Infectious Diseases. Tuberculose multirresistente. |
title |
Multi-drug-resistant tuberculosis in a Department of Infectious Diseases. |
spellingShingle |
Multi-drug-resistant tuberculosis in a Department of Infectious Diseases. Constant, Carolina Arez |
title_short |
Multi-drug-resistant tuberculosis in a Department of Infectious Diseases. |
title_full |
Multi-drug-resistant tuberculosis in a Department of Infectious Diseases. |
title_fullStr |
Multi-drug-resistant tuberculosis in a Department of Infectious Diseases. |
title_full_unstemmed |
Multi-drug-resistant tuberculosis in a Department of Infectious Diseases. |
title_sort |
Multi-drug-resistant tuberculosis in a Department of Infectious Diseases. |
author |
Constant, Carolina Arez |
author_facet |
Constant, Carolina Arez Ferreira, Pedro Bravo Valadas, Emília Antunes, Francisco |
author_role |
author |
author2 |
Ferreira, Pedro Bravo Valadas, Emília Antunes, Francisco |
author2_role |
author author author |
dc.contributor.author.fl_str_mv |
Constant, Carolina Arez Ferreira, Pedro Bravo Valadas, Emília Antunes, Francisco |
description |
In Western Europe, Portugal has the highest incidence of tuberculosis (TB) as well as HIV infection. At the Department of Infectious Diseases, Hospital de Santa Maria, Lisbon, we have observed a steady increase in cases of drug resistant (DR) and multi-drug resistant (MDR) TB over the last few years. To identify the determinants of drug- resistant tuberculosis, clinical notes from all patients admitted to the Department of Infectious Diseases from 1995 to 2000, with DR- or MDR-TB were retrospectively reviewed. A total of 212 samples, from 190 patients with tuberculosis were tested for sensitivity to first line anti-TB drugs, using standard methods. Most patients (61%) were intravenous drugs users. Resistance to at least one drug was found in 44 patients (23%); notes were available for review in 39 (36 HIV infected) patients. The rate of DR-TB was 9% (n=16) and that of MDR-TB was 15% (n=28). Almost half of the MDR-TB cases (n=13) showed resistance to four drugs (HRSE). Thirteen patients (69%) were first diagnosed as fully sensitive tuberculosis, during their first admission to the Department; however, later on they developed MDR-TB or DR-TB. Non-compliance with therapy and the intravenous use of drugs were associated with MDR-TB. The large increase in MDR-TB in our Department is of great concern. The clustering of identical resistance patterns suggest transmission of TB from a single source patient that may well have occurred in a nosocomial context. Traditional tuberculosis control measures seem to be insufficient in settings were prevalence of HIV infection and tuberculosis are high. This becomes even more important when the incidence of intravenous substance abuse, and often non-compliance, are predominant factors. Appropriate isolation facilities for all suspected tuberculosis cases as well as rapid diagnostic and drug susceptibility tests will be required to prevent further spread of MDR-TB. |
publishDate |
2004 |
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2004-04-30 |
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info:eu-repo/semantics/publishedVersion |
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https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/1653 oai:ojs.www.actamedicaportuguesa.com:article/1653 |
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https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/1653 |
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por |
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https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/1653 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/1653/1234 |
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Ordem dos Médicos |
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Ordem dos Médicos |
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Acta Médica Portuguesa; Vol. 17 No. 2 (2004): Março-Abril; 157-66 Acta Médica Portuguesa; Vol. 17 N.º 2 (2004): Março-Abril; 157-66 1646-0758 0870-399X reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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