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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
Author and Funding Information

Affiliations: From the Department of Medicine, Eastern Maine Medical Center, Bangor, Maine,  From the Department of Medicine, Stanford University Medical Center, Palo Alto, California,  From the Hospital Rodolfo Robles, Quetzaltenango, Guatemala,  From the Division of Public Health Biology and Epidemiology, School of Public Health, University of California, Berkeley

Affiliations: From the Department of Medicine, Eastern Maine Medical Center, Bangor, Maine,  From the Department of Medicine, Stanford University Medical Center, Palo Alto, California,  From the Hospital Rodolfo Robles, Quetzaltenango, Guatemala,  From the Division of Public Health Biology and Epidemiology, School of Public Health, University of California, Berkeley

Affiliations: From the Department of Medicine, Eastern Maine Medical Center, Bangor, Maine,  From the Department of Medicine, Stanford University Medical Center, Palo Alto, California,  From the Hospital Rodolfo Robles, Quetzaltenango, Guatemala,  From the Division of Public Health Biology and Epidemiology, School of Public Health, University of California, Berkeley

Affiliations: From the Department of Medicine, Eastern Maine Medical Center, Bangor, Maine,  From the Department of Medicine, Stanford University Medical Center, Palo Alto, California,  From the Hospital Rodolfo Robles, Quetzaltenango, Guatemala,  From the Division of Public Health Biology and Epidemiology, School of Public Health, University of California, Berkeley


1998 by the American College of Chest Physicians


Chest. 1998;113(6):1452-1458. doi:10.1378/chest.113.6.1452
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Published online

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.


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