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Tendencias en la tuberculosis resistente a los medicamentos en los Estados Unidos, 1993-1996
M Moore1, I M Onorato, E McCray
1Division of Tuberculosis Elimination, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
JAMA
|September 18, 1997
Resumen
La tuberculosis multirresistente (MDR TB) sigue siendo un desafío, con el 2,2% de los casos resistentes a la isoniazida y la rifampicina. Los pacientes nacidos en el extranjero, VIH positivos y tratados previamente muestran tasas de resistencia más altas.
Área de la Ciencia:
- Salud Pública La salud pública.
- Enfermedades infecciosas Enfermedades infecciosas.
- Epidemiología La epidemiología.
Sus antecedentes:
- La tuberculosis (TB) resurgió en los Estados Unidos a fines de la década de 1980, lo que condujo a un aumento de la tuberculosis multirresistente (MDR TB).
- Los Centros para el Control y la Prevención de Enfermedades (CDC) iniciaron la vigilancia nacional para las pruebas de susceptibilidad a los medicamentos en 1993 para monitorear las tendencias de resistencia.
Objetivo del estudio:
- Evaluar la prevalencia y los patrones de la tuberculosis resistente a los medicamentos en los Estados Unidos.
- Para identificar grupos de pacientes con mayores tasas de resistencia a los medicamentos.
Principales métodos:
- Análisis de los datos nacionales de vigilancia de la TB de 1993 a 1996.
- Inclusión de casos de tuberculosis cultivo-positivos reportados por los 50 estados, la ciudad de Nueva York y el Distrito de Columbia.
- Cálculo de los porcentajes de resistencia a medicamentos antituberculosos específicos.
Principales resultados:
- Las tasas generales de resistencia: isoniazida (8,4%), rifampicina (3,0%), TB MDR (2,2%), pirazinamida (3,0%), estreptomicina (6,2%), clorhidrato de etambutol (2,2%).
- Se observaron tasas más altas de resistencia en pacientes con antecedentes de episodios previos de TB.
- Los pacientes nacidos en el extranjero y aquellos con infección por VIH mostraron una mayor resistencia a ciertos medicamentos, particularmente la isoniazida y la rifampicina.
Conclusiones:
- La resistencia a la isoniazida se mantuvo estable en comparación con las encuestas anteriores, mientras que la TB MDR disminuyó a nivel nacional, influenciada por una caída significativa en la ciudad de Nueva York.
- Los individuos nacidos en el extranjero, los pacientes VIH-positivos y aquellos con infecciones previas de tuberculosis corren un mayor riesgo de resistencia a los medicamentos.
- La prevalencia persistente de la resistencia a la isoniazida subraya la necesidad crítica de pruebas de susceptibilidad a los fármacos en el manejo de los casos de TB positivos en cultivo.
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