Abstract
The setting for this retrospective cohort study was a specialised tuberculosis unit in Madrid, Spain. The objective was to describe the risk factors for multidrug-resistant tuberculosis (MDR-TB). The medical records of all patients admitted to the unit were reviewed retrospectively to identify factors associated with multidrug resistance. Patients with positive culture for M. tuberculosis and with available drug-susceptibility tests were included. The variables assessed were age, gender, country of origin, homelessness, alcohol consumption, intravenous drug use, methadone substitution therapy, contact with a tuberculosis patient, sputum smear, site of disease, previous tuberculosis treatment, HIV infection, history of imprisonment, diabetes mellitus and chronic obstructive pulmonary disease. Thirty patients with MDR-TB and 666 patients with non-MDR-TB were included from the years 1997 to 2006. The only factors associated with MDR-TB in multivariate analysis were previous tuberculosis treatment (OR: 3.44; 95% CI: 1.58–7.50; p = 0.003), age group 45–64 years (OR: 3.24; 95% CI: 1.34–7.81; p = 0.009) and alcohol abuse (OR: 0.12; 95% CI: 0.03 to 0.55; p = 0.003). In our study, patients who had had previous treatment for tuberculosis, who were 45–64 years of age or who had no history of alcohol abuse were more likely to have MDR-TB.
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Zignol M, Hosseini MS, Wright A, Weezenbeek CL, Nunn P, Watt CJ et al (2006) Global incidence of multidrug-resistant tuberculosis. J Infect Dis 194(4):479–485. doi:10.1086/505877
Espinal MA, Laszlo A, Simonsen L, Boulahbal F, Kim SJ, Reniero A et al (2001) Global trends in resistance to antituberculosis drugs. World Health Organization-International Union against Tuberculosis and Lung Disease Working Group on Anti-Tuberculosis Drug Resistance Surveillance. N Engl J Med 344(17):1294–1303. doi:10.1056/NEJM200104263441706
EuroTB and the national coordinators for tuberculosis surveillance in the WHO European Region (2007) Surveillance of tuberculosis in Europe. Report on tuberculosis cases notified in 2005. Institut de veille sanitaire, Saint-Maurice
Servicio de Epidemiología (2006) Instituto de Salud Pública. Registro Regional de casos de Tuberculosis de la Comunidad de Madrid. Informe del año 2004. Bol Epidemiol Comun Madr 5(12):4–38
Faustini A, Hall AJ, Perucci CA (2006) Risk factors for multidrug resistant tuberculosis in Europe: a systematic review. Thorax 61(2):158–163. doi:10.1136/thx.2005.045963
Casal M, Vaquero M, Rinder H, Tortoli E, Grosset J, Rusch-Gerdes S et al (2005) A case-control study for multidrug-resistant tuberculosis: risk factors in four European countries. Microb Drug Resist 11(1):62–67. doi:10.1089/mdr.2005.11.62
Espinal MA, Laserson K, Camacho M, Fusheng Z, Kim SJ, Tlali RE et al (2001) Determinants of drug-resistant tuberculosis: analysis of 11 countries. Int J Tuberc Lung Dis 5(10):887–893
Torres L, Arazo P, Blas Perez J, del Pilar Amador M, Antonia Lezcano M, Jose Revillo M et al (2000) Resistance of Mycobacterium tuberculosis in Zaragoza, Spain (1993–1997) and related factors. Med Clin (Barc) 115(16):605–609
Martin-Casabona N, Alcaide F, Coll P, Gonzalez J, Manterola JM, Salvado M et al (2000) Drug resistance in Mycobacterium tuberculosis. A multicenter study of the Barcelona area. Grupo de Trabajo sobre Resistencias en Tuberculosis. Med Clin (Barc) 115(13):493–498
Laserson KF, Thorpe LE, Leimane V, Weyer K, Mitnick CD, Riekstina V et al (2005) Speaking the same language: treatment outcome definitions for multidrug-resistant tuberculosis. Int J Tuberc Lung Dis 9(6):640–645
World Health Organization (2007) Global tuberculosis control: surveillance, planning and financing. World Health Organization, Geneva
Canetti G, Rist N, Grosset J (1963) Measurement of sensitivity of the tuberculous bacillus to antibacillary drugs by the method of proportions. Methodology, resistance criteria, results and interpretation. Rev Tuberc Pneumol (Paris) 27:217–272
Toungoussova S, Caugant DA, Sandven P, Mariandyshev AO, Bjune G (2002) Drug resistance of Mycobacterium tuberculosis strains isolated from patients with pulmonary tuberculosis in Archangels, Russia. Int J Tuberc Lung Dis 6(5):406–414
World Health Organization (2006) Guidelines for the programmatic management of drug-resistant tuberculosis. World Health Organization, Geneva
Spradling P, Nemtsova E, Aptekar T, Shulgina M, Rybka L, Wells C et al (2002) Anti-tuberculosis drug resistance in community and prison patients, Orel Oblast, Russian Federation. Int J Tuberc Lung Dis 6(9):757–762
Garcia Rodriguez JF, Marino Callejo A, Lorenzo Garcia MV, Rodriguez Mayo M, Dominguez Gomez D, Sesma Sanchez P (1999) Resistance of Mycobacterium tuberculosis in Ferrol, Spain. Associated factors. Med Clin (Barc) 113(15):572–574
Arevalo M, Solera J, Cebrian D, Bartolome J, Robles P (1996) Risk factors associated with drug-resistant Mycobacterium tuberculosis in Castilla-la-Mancha (Spain). Eur Respir J 9(2):274–278. doi:10.1183/09031936.96.09020274
Fleming MF, Krupitsky E, Tsoy M, Zvartau E, Brazhenko N, Jakubowiak W et al (2006) Alcohol and drug use disorders, HIV status and drug resistance in a sample of Russian TB patients. Int J Tuberc Lung Dis 10(5):565–570
Shin SS, Pasechnikov AD, Gelmanova IY, Peremitin GG, Strelis AK, Mishustin S et al (2006) Treatment outcomes in an integrated civilian and prison MDR-TB treatment program in Russia. Int J Tuberc Lung Dis 10(4):402–408
Jakubowiak WM, Bogorodskaya EM, Borisov SE, Danilova ID, Kourbatova EV (2007) Risk factors associated with default among new pulmonary TB patients and social support in six Russian regions. Int J Tuberc Lung Dis 11(1):46–53
Santha T, Garg R, Frieden TR, Chandrasekaran V, Subramani R, Gopi PG et al (2002) Risk factors associated with default, failure and death among tuberculosis patients treated in a DOTS programme in Tiruvallur District, South India, 2000. Int J Tuberc Lung Dis 6(9):780–788
Jaggarajamma K, Sudha G, Chandrasekaran V, Nirupa C, Thomas A, Santha T et al (2007) Reasons for non-compliance among patients treated under Revised National Tuberculosis Control Programme (RNTCP), Tiruvallur district, south India. Indian J Tuberc 54(3):130–135
Gelmanova IY, Keshavjee S, Golubchikova VT, Berezina VI, Strelis AK, Yanova GV et al (2007) Barriers to successful tuberculosis treatment in Tomsk, Russian Federation: non-adherence, default and the acquisition of multidrug resistance. Bull World Health Organ 85(9):703–711. doi:10.2471/BLT.06.038331
Moniruzzaman A, Elwood RK, Schulzer M, FitzGerald JM (2006) A population-based study of risk factors for drug-resistant TB in British Columbia. Int J Tuberc Lung Dis 10(6):631–638
Wells CD, Cegielski JP, Nelson LJ, Laserson KF, Holtz TH, Finlay A et al (2007) HIV infection and multidrug-resistant tuberculosis: the perfect storm. J Infect Dis 196 [Suppl 1]:S86–S107. doi:10.1086/518665
De March Ayuela P (2001) Drug-resistant tuberculosis in Spain. Trends and influence of the human immunodeficiency virus. Med Clin (Barc) 117(2):59–63
Grupo de Estudio de Tuberculosis Resistente de Madrid Multicenter transversal study of tuberculosis and drug resistance in Madrid (October 1993–April 1994) (1996) Med Clin (Barc) 106(1):1–6
Djuretic T, Herbert J, Drobniewski F, Yates M, Smith EG, Magee JG et al (2002) Antibiotic resistant tuberculosis in the United Kingdom: 1993–1999. Thorax 57(6):477–482. doi:10.1136/thorax.57.6.477
Drobniewski FA, Watterson SA, Wilson SM, Harris GS (2000) A clinical, microbiological and economic analysis of a national service for the rapid molecular diagnosis of tuberculosis and rifampicin resistance in Mycobacterium tuberculosis. J Med Microbiol 49(3):271–278
Acknowledgements
We thank José Gallegos for his help with the database design and data management. We thank Rosario Madero, Jesús Díez and Belén San José for helpful comments on the interpretation of results. We thank Santiago Pérez Cachafeiro for helpful comments.
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Suárez-García, I., Rodríguez-Blanco, A., Vidal-Pérez, J.L. et al. Risk factors for multidrug-resistant tuberculosis in a tuberculosis unit in Madrid, Spain. Eur J Clin Microbiol Infect Dis 28, 325–330 (2009). https://doi.org/10.1007/s10096-008-0627-y
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DOI: https://doi.org/10.1007/s10096-008-0627-y