RESUMO
OBJECTIVES: To describe the prevalence, associated factors, treatment outcomes and transmission of extensively drug-resistant (XDR) tuberculosis (TB) in the state of São Paulo, Brazil, for 2011 to 2013. METHODS: Drug susceptibility testing to first- and second-line drugs was performed by BACTEC MGIT 960 and molecular typing, by IS6110 restriction fragment length polymorphism. Clinical, epidemiologic and demographic data were obtained from surveillance information systems for TB. Patients were divided into three groups: multidrug resistant (MDR) TB (resistance to at least isoniazid and rifampicin), pre-XDR-TB (MDR-TB resistant to a fluoroquinolone or to at least one of the second-line injectable drugs) and XDR-TB (MDR-TB resistant to a fluoroquinolone and to at least one of the second-line injectables). RESULTS: Among the 313 MDR-TB patients identified, the prevalence of XDR-TB and pre-XDR-TB was 10.2% (n = 32) and 19.2% (n = 60), respectively. Compared to MDR-TB patients, XDR-TB patients were more likely to be female (odds ratio (OR) = 2.74, 95% confidence interval (CI), 1.29-5.83), have a history of TB (OR = 5.16; 95% CI, 1.52-17.51) and present higher death rates (OR= 3.74; 95% CI 1.70-8.25). XDR-TB transmission was observed in households, between neighbours and between a patient and a healthcare worker in a hospital. CONCLUSIONS: The prevalence of XDR-TB in the state of São Paulo is close to that estimated globally. Most of the XDR-TB patients were treated previously for TB and presented the lowest successful outcome rates. Because transmission of XDR-TB occurred, it is important that timely diagnosis of drug resistance is performed.
Assuntos
Tuberculose Extensivamente Resistente a Medicamentos/epidemiologia , Tuberculose Extensivamente Resistente a Medicamentos/transmissão , Mycobacterium tuberculosis , Antituberculosos/farmacologia , Antituberculosos/uso terapêutico , Brasil/epidemiologia , Estudos Transversais , Farmacorresistência Bacteriana Múltipla , Tuberculose Extensivamente Resistente a Medicamentos/tratamento farmacológico , Tuberculose Extensivamente Resistente a Medicamentos/microbiologia , Feminino , Humanos , Masculino , Mycobacterium tuberculosis/classificação , Mycobacterium tuberculosis/efeitos dos fármacos , Mycobacterium tuberculosis/genética , Avaliação de Resultados em Cuidados de Saúde , Polimorfismo de Fragmento de Restrição , Prevalência , Vigilância em Saúde Pública , Fatores de RiscoRESUMO
Os autores, integrados com o Distrito Sanitário de Santo Amaro (Secretaria de Saúde do Estado de Säo Paulo), estäo realizando um trabalho de investigaçäo e encaminhamento para tratamento de casos de tuberculose. O objetivo é contribuir para a descoberta de casos de tuberculose em sintomáticos respiratórios adultos, através de exame baciloscópico de escarro, nos Postos de Atendimento Médico, do Departamento de Saúde da Comunidade, Regiäo Sul. Demonstram que é possível, apenas com os recursos a nível local, viabilizar um projeto de aumento da atuaçäo dos Postos de Atendimento Médico da Prefeitura de Säo Paulo, nos programas de Saúde Pública
