Risk factors associated with multidrug-resistant tuberculosis in Espírito Santo, Brazil

Abstract

OBJECTIVE To analyze the prevalence and factors associated with multidrug-resistant tuberculosis in Espírito Santo, Brazil.METHODS This is a cross-sectional study of cases of tuberculosis tested for first-line drugs (isoniazid, rifampicin, pyrazinamide, ethambutol, and streptomycin) in Espírito Santo between 2002 and 2012. We have used laboratory data and registration of cases of tuberculosis – from the Sistema Nacional de Agravos de Notificação and Sistema para Tratamentos Especiais de Tuberculose. Individuals have been classified as resistant and non-resistant and compared in relation to the sociodemographic, clinical, and epidemiological variables. Some variables have been included in a logistic regression model to establish the factors associated with resistance.RESULTS In the study period, 1,669 individuals underwent anti-tuberculosis drug susceptibility testing. Of these individuals, 10.6% showed resistance to any anti-tuberculosis drug. The rate of multidrug resistance observed, that is, to rifampicin and isoniazid, has been 5%. After multiple analysis, we have identified as independent factors associated with resistant tuberculosis: history of previous treatment of tuberculosis [recurrence (OR = 7.72; 95%CI 4.24–14.05) and re-entry after abandonment (OR = 3.91; 95%CI 1.81–8.43)], smoking (OR = 3.93; 95%CI 1.98–7.79), and positive culture for Mycobacterium tuberculosis at the time of notification of the case (OR = 3.22; 95%CI 1.15–8.99).CONCLUSIONS The partnership between tuberculosis control programs and health teams working in the network of Primary Health Care needs to be strengthened. This would allow the identification and monitoring of individuals with a history of previous treatment of tuberculosis and smoking. Moreover, the expansion of the offer of the culture of tuberculosis and anti-tuberculosis drug susceptibility testing would provide greater diagnostic capacity for the resistant types in Espírito Santo.

Caracterização da tuberculose drogarresistente no Brasil, 2014*

“…14 MDR-TB predominance among DR-TB was also found in the Brazilian state of Espírito Santo: 47.7% between 2002 and 2012; 9 the poly-resistance, reported by the same study was higher than the percentages we found (namely 14.0% and 9.5%). 9 Regarding forms of mono-resistance, our results show predominance of mono-resistance to isoniazid, followed by mono-resistance to rifampicin. Similar results were found in previous studies.…”

“…Similar results were found in previous studies. 5,7,9 Notwithstanding, predominant mono-resistance to streptomycin had already been reported in the municipality of São José do Rio Preto, in the state of São Paulo, between 2009 and 2013. 6 The number of pulmonary MDR-TB cases reported in 2014 accounted for 43.7% of those estimated by WHO for Brazil that year (19.4% of primary cases and 64.7% of acquired cases).…”

“…The predominance of men, Afro-Brasilian, young people, and people with low levels of education was also found in other municipal, state and local studies between 2000 and 2013; with an exception in the municipality of Porto Alegre, in the state of Rio Grande do Sul, between 2006 and 2007, when most DR-TB cases (64.3%) were w hite individuals. [5][6][7][8][9][17][18][19][20] This variation is possibly due to regional differences in the ethnic composition of population. The DR-TB case profile is the same as that associated with treatment of drug-sensitive TB cases loss to follow-up.…”

“…24 In relation to diabetes, the percentage we found was in-between those found in Porto Alegre and in the states of Espírito Santo and Amazonas between 2000 and 2013 (they ranged from 7.7% to Drug-resistant tuberculosis in Brazil 13.6%). 5,9,20 Diabetes has the potential to interfere with TB treatment, with higher risk of treatment failure, TB recurrence and death. 25 The relative frequency of substance use is consistent with that found in São José do Rio Preto between 2009 and 2013, 6 as well as among MDR-TB cases at the São Paulo State Referral Center in 2010.…”

“…3 In 2006, 1.4% of new TB cases and 7.5% of previously treated cases were MDR-TB. 4 When describing the epidemiological profile of DR-TB, recent Brazilian studies have used local data [5][6][7][8][9] rather than national data.…”