Programa de Controle da Tuberculose, Secretaria de Estado de Saúde e Defesa Civil do Rio de Janeiro, Rua México 128, Sala 411, Centro, Rio de Janeiro 20031 142, RJ, Brazil.
Int J Tuberc Lung Dis. 2010 Jan;14(1):24-33.
Tuberculosis (TB) drug resistance survey in six hospitals in Rio de Janeiro, Brazil.
To estimate resistance to at least one drug (DR) and multidrug resistance (MDR) and identify associated factors.
One-year cross-sectional survey. Hospitals were included as a convenience sample.
Of 595 patients investigated, 156 (26.2%) had previously undergone anti-tuberculosis treatment, 433 (72.8%) were not previously treated and information on the remaining 6 was not available. Overall, DR and MDR rates were high, at respectively 102 (17.1%, 95%CI 14.3-20.5) and 44 (7.4%, 95%CI 5.5-9.9) cases. Among individuals not previously treated, 17 had MDR (3.9%, 95%CI 2.4-6.3) and diagnosis in a TB reference hospital was independently associated with MDR (prevalence ratio [PR] 3.3, 95%CI 1.2-8.7) after multivariate analysis. Among previously treated individuals, 27 had MDR (17.3%, 95%CI 11.7-24.2). MDR-TB was independently associated with diagnosis in a TB reference hospital (PR 3.6, 95%CI 1.5-8.7), male sex (PR 2.3, 95%CI 1.2-4.4) and dyspnoea (PR 0.3, 95%CI 0.1-0.7).
We found high levels of DR- and MDR-TB. Our study design did not permit us to determine the contribution of community versus nosocomial transmission. Further studies are needed to establish this. Nevertheless, hospitals should be recognised as a potential source of transmission of resistant TB strains and urgent measures to avoid nosocomial TB transmission should be taken.
巴西里约热内卢六家医院的结核病（TB）耐药调查。
估计至少一种药物耐药（DR）和耐多药（MDR）的发生率，并确定相关因素。
为期一年的横断面调查。医院作为便利样本被纳入。
共调查了 595 名患者，其中 156 名（26.2%）有过抗结核治疗史，433 名（72.8%）未治疗过，其余 6 名患者的信息不详。总体而言，DR 和 MDR 发生率较高，分别为 102 例（17.1%，95%CI 14.3-20.5）和 44 例（7.4%，95%CI 5.5-9.9）。在未经治疗的患者中，有 17 例（3.9%，95%CI 2.4-6.3）为 MDR，经多变量分析后，在 TB 参考医院诊断与 MDR 独立相关（比值比 [PR] 3.3，95%CI 1.2-8.7）。在经治患者中，有 27 例（17.3%，95%CI 11.7-24.2）为 MDR-TB。在 TB 参考医院诊断（PR 3.6，95%CI 1.5-8.7）、男性（PR 2.3，95%CI 1.2-4.4）和呼吸困难（PR 0.3，95%CI 0.1-0.7）与 MDR-TB 独立相关。
我们发现 DR-TB 和 MDR-TB 的发生率均较高。我们的研究设计无法确定社区传播与医院传播的相对贡献，需要进一步研究来确定这一点。然而，医院应被视为耐药结核菌株传播的潜在来源，应采取紧急措施避免医院内 TB 传播。
