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The MODS method for diagnosis of tuberculosis and multidrug resistant tuberculosis
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Resistencia a múltiples fármacos entre las personas con tuberculosis en California, 1994-2003
Reuben M Granich1, Peter Oh, Bryan Lewis
1Division of TB Elimination, National Center for HIV, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Ga, USA. granichrm@state.gov
JAMA
|June 9, 2005
Resumen
La tuberculosis multirresistente (MDR-TB) sigue siendo una amenaza persistente en California, afectando al 1,4% de los casos a pesar de los esfuerzos de control. Los principales factores de riesgo incluyen el tratamiento previo para la tuberculosis y la inmigración reciente, con menores tasas de finalización del tratamiento observadas.
Área de la Ciencia:
- Salud Pública La salud pública.
- Enfermedades infecciosas Enfermedades infecciosas.
- Epidemiología La epidemiología.
Sus antecedentes:
- Los casos de tuberculosis (TB) en California disminuyeron en un 33% entre 1994 y 2003.
- A pesar de la disminución general, California reportó el mayor número de casos de TB a nivel nacional en 2003.
- La proporción de casos de tuberculosis multirresistente (MDR-TB) se ha mantenido sin cambios en la última década.
Objetivo del estudio:
- Para analizar la prevalencia, las tendencias, la distribución geográfica, las características clínicas, los factores de riesgo y los resultados de la MDR-TB en California.
- Examinar 38.291 casos de tuberculosis reportados entre 1994 y 2003 en las 61 jurisdicciones sanitarias de California.
- La MDR-TB se definió como la resistencia a la isoniazida y la rifampicina.
Principales métodos:
- Se realizaron análisis univariados y multivariados.
- Los datos fueron extraídos del registro de California de informes de casos verificados de tuberculosis.
- Los factores asociados con la MDR-TB fueron identificados a través de modelos estadísticos.
Principales resultados:
- El 1,4% (407/28,712) de los casos de TB analizados fueron MDR-TB, sin cambios significativos en la proporción a lo largo del tiempo (P = .87).
- Los casos de MDR-TB tenían más probabilidades de tener lesiones cavitarias (2 veces) y tratamiento previo para la TB (7 veces).
- Los pacientes con tuberculosis multirresistente tenían tasas de finalización de la terapia significativamente más bajas (67% vs. no-MDR-TB).
Conclusiones:
- La MDR-TB persiste en el 1-2% de los casos en California, a pesar de las medidas de control.
- Las opciones limitadas de tratamiento y los altos costos asociados con la MDR-TB requieren esfuerzos continuos.
- Las estrategias locales y globales mejoradas de control de la TB son cruciales para prevenir el desarrollo y la transmisión de MDR-TB.
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