RISK-FACTORS FOR DRUG-RESISTANT TUBERCULO SIS IN CHIAPAS, MEXICO

Objectives, To determine risk factors for antibiotic resistance in pat ients with pulmonary, tuberculosis in four Health Jurisdictions of the state of Chiapas. Material and Methods, A case-control study was carr ied out in patients diagnosed by acid fast smear during 1992. A questi onnaire was applied which included variables related to the diagnosis, treatment and follow-up of the patients. Sputum samples were collecte d for culture and sensitivity bests. A case of drug-resistant pulmonar y tuberculosis was defined as the presence of culture colonies showing resistance to one OF. more drugs. The control group was patients with negative smears and cultures or positive cultures for M. tuberculosis sensitive to the specific drugs. Results, Of the total of 18 individu als reported to have positive cultures, 13 (72.2 %) were resistent to one or more drugs. Resistance to two or more drugs was found in 10 of them of which three were resistant to five antituberculosis drugs. The most frequent resistance was to isoniazid(77%). Risk factors for resi stance encountered in this patient population were monotherapy (OR = 3 4.2), abandonment of treatment (OR = 6.86), a prolonged period of illn ess (OR = 6.40), delay in diagnosis and a history of prior therapy (OR = 28.3). Conclusions. The high proportion of patients resistant to an tituberculosis therapy poses a public health problem and is a clear co nsequence of the problems arising from inadequate treatment.