EPIDEMIOLOGY AND CLINICAL CONSEQUENCES OF DRUG-RESISTANT TUBERCULOSISIN A GUATEMALAN HOSPITAL

Study objective: To determine the epidemiology and clinical consequenc es of drug-resistant TB in Guatemala. Design: A prospective study cond ucted for 12 months. Setting: A thoracic referral hospital in western Guatemala, Patients: Three hundred and seventy-six patients with confi rmed TB. Results: Of 376 confirmed cases, 335 (89%) were culture-posit ive. Tests of drug sensitivities to four first-line antituberculous dr ugs were performed in 172 (51%) of the culture-positive cases. Fifty-o ne patients (30%) were resistant to at least one antimicrobial agent, and 26 (15%) were resistant to at least two drugs. In a multivariate m odel of clinically available patient characteristics, only cavitary di sease (odds ratio=2.1; 95% confidence interval, 1.1-6.6) and a history of taking anti-TB medication for >2 weeks (OR=3.0; 95% CI, 1.5-10.3) were independent predictors of resistance to two or more anti-TB agent s. Resistance to two or more anti-TB drugs was the single independent predictor of treatment failure (OR=6.4; 95% CI, 2.3-17.8). Twenty-four of 172 patients (14%) who denied having received prior anti-TB therap y were infected with resistant organisms, suggesting ongoing transmiss ion of drug-resistant strains. Although 84% (69 of 82 cases) of patien ts with fully susceptible organisms and 89% (17 of 19 cases) with sing ly resistant organisms were cured, only 45% of patients (10 of 22 case s) infected with organisms resistant to two or more agents were succes sfully treated. Conclusions: At this sentinel site for complicated TB, a substantial subset of cases who are infected with drug-resistant ba cteria cannot be easily identified or treated.