930 High prevalence of multidrug-resistant tuberculosis in inpatients of a tertiary care center

Sunday, March 21, 2010
Grand Hall (Hyatt Regency Atlanta)
Michelle Dugnani, MD , Hospital Heliopolis, Sao Paulo, Brazil
Leandro Soares Sereno, MD , Hospital Heliopolis, Sao Paulo, Brazil
Monica Anselmo Junkes, MD , Hospital Heliopolis, Sao Paulo, Brazil
Marcelo Contardo Moscoso Naveira, MD , Hospital Heliopolis, Sao Paulo, Brazil
Viviane Briese Santos, MD , Hospital Heliopolis, Sao Paulo, Brazil
Heli Ferreira Filho, MD , Hospital Heliopolis, Sao Paulo, Brazil
Juvencio Jose Furtado, MD , Hospital Heliopolis, Sao Paulo, Brazil
Odilon Victor Porto Denardin, MD , Hospital Heliopolis, Sao Paulo, Brazil
Jose Marcos Pereira Costa, MD , Hospital Heliopolis, Sao Paulo, Brazil
Mariangela Negrin Cassiolato , Hospital Heliopolis, Sao Paulo, Brazil
Elisa Maria Beirao, MD , Hospital Heliopolis, Sao Paulo, Brazil
Background: Multidrug-resistant tuberculosis (MDR-TB, defined as resistance to at least isoniazid and rifampicin) has emerged as a serious global public health problem. The extent of the problem in hospitalized patients has been incompletely defined. These patients pose a problem in health care institutions since it is a life threatening disease and the respiratory precautions must be adequate to avoid transmission.

Objective: To determine the prevalence of tuberculosis in hospitalized patients.

Methods: A retrospective study in Hospital Heliopolis, a tertiary care center located in São Paulo, Brazil, where a infectious diseases program with a special focus on HIV/AIDS, hepatitis, tuberculosis and hospital-acquired infections is developed. Inpatients that presented a positive culture from a representative site of infection, with the isolation of Mycobacterium tuberculosis (MTB) between January 2005 and September 2009 were analysed. The clinical and demographic data from patients included in this study were recorded. The isolates were referred to Instituto Adolfo Lutz where susceptibility testing were performed. The statistical software package SPSS v13.0 (SPSS, Inc., Chicago, IL, USA) was used for all of the data analyses.

Results: Of 180 patients with culture-positive MTB, 69.4% were male and 30.6% female, with a median age of 41.1 years-old. A reliable information of not having a previous treatment was obteined from 86 patients (47.8%), 21 (11,7%) assumed a previous treatment for MTB, and 73 (40.6%) this information was not availlable.The infection was considered as  pulmonary tuberculosis in 80 (44.4%) cases and 30(16.7%) presented disseminated disease. No comorbities were found in 33(18.3%) patients,  50 (27.8%) had HIV infection and 16(8.9%) had alcoholism as underlying conditions. Resistance was lower to streptomycin 9(5%), ethambutol 3(1.7%) and pyrazinamide 8(4.4%). However high resistance to isoniazid 22(12.2%)and rifampin 16 (8.9%) was observed. Resistance to isoniazid and rifampin occured in 13(7.2%) of the isolates.

Conclusions: High occurence of MDR-TB in the hospital setting was observed. Respiratory infection control precautions should be implemented and adequate negative pressure rooms should be prefered, had might be a limitation in the developing countries.