Morbi-mortalidad de pacientes con tuberculosis hospitalizados en el Departamento de enfermedades infecciosas, tropicales y dermatológicas del Hospital Nacional Cayetano Heredia, Lima – Perú entre los años 1990 y 2000.

Haro, Raúl Chuquiyauri; Bosteels, Kristien Verdonck; Lagos, Elsa González; Zamudio, Carlos; Zárate, Juan Echevarría; Ramos, Carlos Seas; Herencia, Eduardo Gotuzzo

doi:10.20453/rmh.v15i4.774

Cited by 4 publications

(3 citation statements)

References 7 publications

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“…The management and treatment of MDR-TB is complex; it includes an elevated treatment cost [ 8 ], the use of highly toxic anti-tuberculosis drugs with potential adverse effects [ 9 ], longer treatment time [ 6 ], and it burdens an increased treatment failure and mortality rate [ 10 , 11 ]. In Peru, MDR-TB mortality varies from 20% to 55% [ 12 , 13 ], much greater compared to the 4.5% to 17% mortality of sensitive-TB [ 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Mortality among MDR-TB Cases: Comparison with Drug-Susceptible Tuberculosis and Associated Factors

et al. 2015

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BackgroundAn increase in multidrug-resistant tuberculosis (MDR-TB) cases is evident worldwide. Its management implies a complex treatment, high costs, more toxic anti-tuberculosis drug use, longer treatment time and increased treatment failure and mortality. The aims of this study were to compare mortality between MDR and drug-susceptible cases of tuberculosis, and to determine risk factors associated with mortality among MDR-TB cases.Methods and ResultsA retrospective cohort study was performed using data from clinical records of the National Strategy for Prevention and Control of Tuberculosis in Lima, Peru. In the first objective, MDR-TB, compared to drug-susceptible cases, was the main exposure variable and time to death, censored at 180 days, the outcome of interest. For the second objective, different variables obtained from clinical records were assessed as potential risk factors for death among MDR-TB cases. Cox regression analysis was used to determine hazard ratios (HR) and 95% confidence intervals (95%CI). A total of 1,232 patients were analyzed: mean age 30.9 ±14.0 years, 60.0% were males. 61 patients (5.0%) died during treatment, whereas the MDR-TB prevalence was 19.2%. MDR-TB increased the risk of death during treatment (HR = 7.5; IC95%: 4.1–13.4) when compared to presumed drug-susceptible cases after controlling for potential confounders. Education level (p = 0.01), previous TB episodes (p<0.001), diabetes history (p<0.001) and HIV infection (p = 0.04) were factors associated with mortality among MDR-TB cases.ConclusionsMDR-TB is associated with an increased risk of death during treatment. Lower education, greater number of previous TB episodes, diabetes history, and HIV infection were independently associated with mortality among MDR-TB cases. New strategies for appropriate MDR-TB detection and management should be implemented, including drug sensitivity tests, diabetes and HIV screening, as well as guarantee for a complete adherence to therapy.

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Section: Introductionmentioning

confidence: 99%

Mortality among MDR-TB Cases: Comparison with Drug-Susceptible Tuberculosis and Associated Factors

et al. 2015

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“…La letalidad por tbC en pacientes hospitalizados tiene importantes variaciones en la literatura y va desde de 4,9 a 28,1 en ee.uu. 6,7 , 13% en Israel 8 , 18,4% en Perú 9 . La variabilidad se entiende por importantes diferencias epidemiológicas entre dichas poblaciones, como por ejemplo en edad y co-morbilidades.…”

Section: Discussionunclassified

Impacto de la tuberculosis en el hospital de Puerto Montt

et al. 2018

Rev. chil. enferm. respir.

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Backgroud: Tuberculosis (TB) is still a problem that impacts on hospitals of high complexity. Aim: To assess demand for care and/or hospitalization because of TB in Puerto Montt Hospital (PMH), located in the southern of Chile. Patients and Methods: Retrospective study of all Reloncaví Health Service (RHS) and PMH clinical records, between 2011 and 2015. We include all ambulatory or hospitalized cases of active TB registered in PMH during the period of the study. Results: In RHS there were 298 cases of TB and 64% of them (192/298) was detected in HPM. We present social, economic, epidemiological, clinical, laboratory studies, and specific type of diagnosis of 180 cases that met inclusion criteria: men 62%, mean age 45 ± 19 years-old. The population with lower income was 72%, 4% homeless, 14% with complete high school, 11% illiterate and 19% lived at country side. Main co-morbidities were alcoholism 17%, HIV 12%, Diabetes Mellitus 10%. In the specific group of lung/pleural TB (128 cases) the time with symptoms was often prolonged (15% ≥ 90 days) and imagen studies showed advanced pathology: bilateral infiltrates 73%, affecting three or more lobes 55%, cavitations 34%. 71% (126/180) were hospitalized, because of necessity of more study (50%) or severity (48%), 8% required to enter to the Critical Care Unit (CCU). Twenty-four patients died (13%). Illiteracy and the need for CCU were associated with mortality. Conclusions: In RHS TB is a sanitary problem that affects principally the most poor and vulnerable populations.

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“…Of concern, Peru remains the only South American country with a high-burden of MDR-TB, which is responsible for 10% of all TB, with up to 40% of MDR-TB patients receiving inappropriate therapies [1]. Mortality rates in some districts approach 20–55% [9, 10], compared to 4.5–17% for drug-sensitive TB [11, 12]. The incidence of MDR-TB in Loreto increased by 175% from 2013 to 2014.…”

Section: Introductionmentioning

confidence: 99%

Improving outcomes for multi-drug-resistant tuberculosis in the Peruvian Amazon – a qualitative study exploring the experiences and perceptions of patients and healthcare professionals

McNally

Wildt

Meza

et al. 2019

BMC Health Serv Res

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Background Management for multi-drug-resistant tuberculosis (MDR-TB) is challenging and has poor patient outcomes. Peru has a high burden of MDR-TB. The Loreto region in the Peruvian Amazon is worst affected for reasons including high rates of poverty and poor healthcare access. Current evidence identifies factors that influence MDR-TB medication adherence, but there is limited understanding of the patient and healthcare professional (HCP) perspective, the HCP-patient relationship and other factors that influence outcomes. A qualitative investigation was conducted to explore and compare the experiences and perceptions of MDR-TB patients and their dedicated HCPs to inform future management strategies. Method Twenty-six, semi-structured in-depth interviews were conducted with 15 MDR-TB patients and 11 HCPs who were purposively recruited from 4 of the worst affected districts of Iquitos (capital of the Loreto region). Field notes and transcripts of the two groups were analysed separately using thematic content analysis. Ethics approval was received from the Institutional Research Ethics Committee, Department of Health, Loreto, and the University of Birmingham Internal Research Ethics Committee. Results Four key themes influencing patient outcomes emerged in each participant group: personal patient factors, external factors, clinical factors, and the HCP-patient relationship. Personal factors included high standard patient and population knowledge and education, which can facilitate engagement with treatment by encouraging belief in evidence-based medicine, dispelling belief in natural medicines, health myths and stigma. External factors included the adverse effect of the financial impact of MDR-TB on patients and their families. An open, trusting and strong HCP-patient relationship emerged as a vitally important clinical factor influencing of patient outcomes. The results also provide valuable insight into the dynamic of the relationship and ways in which a good relationship can be fostered. Conclusions This study highlights the importance of financial support for patients, effective MDR-TB education and the role of the HCP-patient relationship. These findings add to the existing evidence base and provide insight into care improvements and policy changes that could improve outcomes if prioritised by local and national government. Electronic supplementary material The online version of this article (10.1186/s12913-019-4429-y) contains supplementary material, which is available to authorized users.

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Morbi-mortalidad de pacientes con tuberculosis hospitalizados en el Departamento de enfermedades infecciosas, tropicales y dermatológicas del Hospital Nacional Cayetano Heredia, Lima – Perú entre los años 1990 y 2000.

Cited by 4 publications

References 7 publications

Mortality among MDR-TB Cases: Comparison with Drug-Susceptible Tuberculosis and Associated Factors

Mortality among MDR-TB Cases: Comparison with Drug-Susceptible Tuberculosis and Associated Factors

Impacto de la tuberculosis en el hospital de Puerto Montt

Improving outcomes for multi-drug-resistant tuberculosis in the Peruvian Amazon – a qualitative study exploring the experiences and perceptions of patients and healthcare professionals

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