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(Chest. 1998;113:1452-1458.)
© 1998 American College of Chest Physicians

Epidemiology and Clinical Consequences of Drug-Resistant Tuberculosis in a Guatemalan Hospital

Edward M. Harrow MD, FCCP1; Josefa M. Rangel MD2; J. Manuel Arriega BS3; Isaac Cohen MD, FCCP3; Marta Ileana de Leon Régil Ruíz MD3; Kathryn DeRiemer MPH4; and Peter M. Small MD2

1 From the Department of Medicine, Eastern Maine Medical Center, Bangor, Maine
2 From the Department of Medicine, Stanford University Medical Center, Palo Alto, California
3 From the Hospital Rodolfo Robles, Quetzaltenango, Guatemala
4 From the Division of Public Health Biology and Epidemiology, School of Public Health, University of California, Berkeley

Study objective: To determine the epidemiology and clinical consequences of drug-resistant TB in Guatemala.

Design: A prospective study conducted for 12 months.

Setting: A thoracic referral hospital in western Guatemala.

Patients: Three hundred and seventy-six patients with confirmed TB.

Results: Of 376 confirmed cases, 335 (89%) were culture-positive. Tests of drug sensitivities to four first-line antituberculous drugs were performed in 172 (51%) of the culture-positive cases. Fifty-one patients (30%) were resistant to at least one antimicrobial agent, and 26 (15%) were resistant to at least two drugs. In a multivariate model of clinically available patient characteristics, only cavitary disease (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 agents. 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 therapy were infected with resistant organisms, suggesting ongoing transmission of drug-resistant strains. Although 84% (69 of 82 cases) of patients with fully susceptible organisms and 89% (17 of 19 cases) with singly resistant organisms were cured, only 45% of patients (10 of 22 cases) infected with organisms resistant to two or more agents were successfully treated.

Conclusions: At this sentinel site for complicated TB, a substantial subset of cases who are infected with drug-resistant bacteria cannot be easily identified or treated.

Key Words: drug resistance • epidemiology • Guatemala • therapy • tuberculosis

Submitted on June 4, 1997
Accepted on October 21, 1997




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L. P. Manangan and W. R. Jarvis
Preventing Multidrug-Resistant Tuberculosis and Errors in Tuberculosis Treatment Around the Globe
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