Multidrug-resistant tuberculosis in Lisbon: unfavourable treatment and associated factors, 2000–2014

Abstract

SETTING: The incidence of tuberculosis (TB) has been decreasing in Portugal. Lisbon concentrates the largest number of cases of multidrug-resistant (MDR) TB in the country. This study aims at identifying clinical and demographic factors associated with unfavourable treatment results of patients with MDR-TB in the city.METHOD: The data on 265 MDR-TB cases, notified from 2000 to 2014 in the District of Lisbon, were collected from the Tuberculosis Surveillance System. Unfavourable cases were classified as failure, loss to follow-up (LTFU) and death. Bivariate and multivariate logistic regressions were undertaken to estimate the factors associated with unfavourable outcomes, LTFU and death.RESULTS: The proportion of unfavourable outcomes was 30.5%. These were associated mostly with being male, foreign-born and resistant to kanamycin. Death was associated with being human immunodeficiency virus-positive and resistant to kanamycin. Being foreign-born had a 4.46-fold higher odds of a LTFU outcome than did being Portuguese-born. The foreign-born patients were mostly African immigrants.CONCLUSION: The main finding in this study is that foreign-born patients are associated with a higher probability of unfavourable outcomes than Portuguese-born patients. Therefore, foreign-born patients need more careful monitoring in the control of MDR-TB.

Fatores de risco para desfechos desfavoráveis de tratamento em pacientes diagnosticados com tuberculose drogarresistente em hospital de referência no Estado do Rio de Janeiro

“…O sexo masculino esteve associado tanto ao desfecho desfavorável quanto ao óbito. Esse fato pode ser explicado devido a componentes comportamentais como o uso de álcool e drogas, mais frequente entre os homens e, geralmente, está associado a resultados desfavoráveis do tratamento (Bhering et al, 2019b).…”

Similaridades e diferenças no tratamento de tuberculose multidroga resistente no Rio de Janeiro e Lisboa na perspectiva dos profissionais de saúde

“…Mesmo com a tendência de queda, a taxa média da TB-MDR entre os estrangeiros, no período 2000-2014, era 7,6 vezes maior do que entre os portugueses. Além disso, ser estrangeiro esteve associado 3 vezes mais ao insucesso e 4 vezes mais ao abandono do tratamento (Bhering et al, 2019a). Outro estudo observou que, em Portugal, casos TB-MDR eram mais propensos de terem nascido em outros países que os casos de TB não MDR (27,3% vs. 13,6%) (Oliveira et al, 2020).…”

Multidrug-Resistant Tuberculosis in Portugal: Patients’ Perception of the Challenges Faced during Treatment

“…Although treatment failure is the central hypothesis regarding the development of resistance to multiple drugs, only 2 patients reported having had previous TB treatment and only 1 defaulted. In Lisbon, the predominance of primary infection can be explained by the endemic circulation of MDR strains of TB [18].…”