Anti-tuberculosis drug resistance, particularly multiresistance, is a crucial issue in the control of tuberculosis (TB). This study estimated the prevalence of primary and acquired anti-tuberculosis drug resistance in strains of Mycobacterium tuberculosis isolated from hospitalized patients, to identify the risk factors for resistance, and to evaluate the its impact on hospital mortality for tuberculosis. Strains of Mycobacterium tuberculosis from 217 patients hospitalized for TB were analyzed. Subjects were recruited sequentially at a TB reference hospital in Salvador, Bahia, Brazil from July 2001 to July 2003. Multiresistant (MR) strains were defined as strains resistant to rifampicin and isoniazid. Of a total of 217 strains isolated, 41 (19.0%, 95%CI: 14.1-24.5%) were resistant to at least one drug. Prevalence of primary resistance was 7.0% (10/145), while a prevalence of 43.1% (31/72) was found for acquired resistance. Primary resistance to one drug alone was found in 2.1% (3/145) and acquired monoresistance in 5.6% (4/72). Prevalence of MR strains in general was 14.3% (31/217), of which 4.2% (6/145) consisted of primary MR and 34.7% (25/72) of acquired MR. Three strains showed resistance to more than one drug, but were not classified as MR. In the multivariate analysis, abandoning treatment remained strongly associated with resistance (adjusted OR: 7.21; 95%CI: 3.27-15.90; p<0.001) following adjustment for 3 potential confounders (gender, alcohol dependence and HIV-infection). An association was found between resistance and mortality from tuberculosis, even after adjustment for HIV status, age, sex and alcohol dependence (adjusted OR: 7.13; 95%CI: 2.25-22.57; p<0.001). High prevalences of resistance, principally acquired resistance including MR, were found in patients hospitalized for TB in Bahia. This finding was strongly associated with having abandoned treatment, and confirmed the need to standardize the procedure for requesting sensitivity tests in this population at the time of hospital admission.
HIV infection is an important risk factor for the development of tuberculosis (TB), and also affects its morbidity and mortality. This study estimated the prevalence of HIV infection in patients hospitalized for TB in Bahia (in northeastern Brazil) and to evaluate its impact on in-hospital mortality. A total of 375 patients with TB, admitted consecutively to a TB reference hospital in Salvador (Bahia, Brazil), were evaluated between July 2001 and July 2003. Anti-HIV serology was performed in all patients irrespective of clinical and/or epidemiological data suggestive of HIV infection. Death during hospitalization was the principal event-dependent variable. Mean age of patients was 41.4 ± 16.2 years and the male/female ratio was 3.4:1.0. The prevalence of HIV infection was 8.8% (95%CI: 6.2-12.0%). Patients in the HIV-positive group were younger than those in the HIV-negative group (37.1 versus 41.9 years; p=0.05). In-hospital mortality was 10.9% for the whole group (95%CI: 9.4-15.9%), but was significantly greater in the HIV-positive group compared to the HIV-negative group (27.3% versus 9.4%; RR=2.9; 95%CI: 1.5-5.6; p=0.002). The prevalence of HIV infection in patients hospitalized for TB in Bahia (northeastern Brazil) is relatively high (8.8%) and mortality is significantly higher (2.9-fold) in the HIV-positive group. These findings justify carrying out HIV testing, as recommended by the Brazilian Ministry of Health, in all TB patients, particularly those requiring hospitalization.
Background: Platinum-based adjuvant chemotherapy (CT) improves survival in surgically resected non-small-cell lung cancer (NSCLC) patients (pts). However, cisplatin and vinorelbine (PV), the most studied regimen, is often associated with increased rates of grade 3-4 toxicities. We aimed to study the efficacy and safety of adjuvant CT in NSCLC pts in a real-world scenario. Methods: We performed a retrospective analysis of NSCLC pts treated with surgery with curative intent between 2009 and 2018 in an academic cancer center. After surgery, pts were accessed to receive adjuvant CT, based on physicians' discretion. Electronic records were reviewed and data were collected for pts and tumor characteristics, treatments, outcomes (overall survival [OS] and disease-free survival [DFS]), and toxicities. OS and DFS were estimated by the Kaplan-Meier method, and curves were compared by log-rank. Prognostic factors were evaluated using Cox regression. Results: 250 consecutive pts were studied: 80 adjuvant CT and 170 observation; 55/80 received PV. Median age 65 years, 62% adenocarcinoma and 28% squamous cell carcinoma. The observation group differed from the adjuvant CT group in terms of type of surgery (lobectomy, 88% vs 76%; p ¼ .020), 7 th ed TNM staging (I, 50% vs 2%; II, 29% vs 45%; III, 20% vs 42%; p < .001), and lymph node status (N0, 71% vs 31%; p < .001). After a median follow-up of 24 months (mo), median DFS was 56.0 vs 39.3 mo in CT and observation groups, and median OS was 61.4 vs 58.5 mo, respectively. In an adjusted analysis, adjuvant CT was associated with improved DFS (HR 0.36, IC 95% 0.23-0.58; p < .001) and OS (HR 0.47, IC 95% 0.28-0.78; p .004). Toxicities were high in the PV group: 49% of the pts required hospitalization, 45% discontinued treatment, and 89% presented grade 3-4 toxicities, including 29% of febrile neutropenia. Five pts (9%) had treatment-related deaths. Conclusions: Our study supports both the OS and DFS benefits of NSCLC adjuvant CT in the real world scenario. However, PV was associated with alarming rates of treatment-related toxicities and deaths, suggesting that new adjuvant avenues are warranted.Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.100P A new PET-CT score for locally-advanced inoperable NSCLC stage III patients treated with chemoradiotherapy
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