Incidencia de la resistencia a drogas en tuberculosis y su asociación a comorbilidades en pacientes tratados en un hospital universitario

La tuberculosis constituye un problema de salud publica con mayor incidencia en paises pobres y presenta dos aspectos a considerar. Las comorbilidades que se comportan como factores de riesgo predisponentes de enfermedad tuberculosa, que pueden complicar su evolucion y tratamiento. Por otra parte la resistencia a drogas antituberculosas de primera linea constituye una amenaza para el control de la TB. Con el objetivo de determinar la incidencia de las entidades comorbidas en pacientes con diagnostico de tuberculosis y la frecuencia de casos con resistencia a drogas se incluyeron en el estudio los pacientes mayores de 16 anos con tuberculosis confirmada en el Hospital de Clinicas "San Jose de San Martin". Se utilizo el programa SSPS 15 para el analisis estadistico. Entre abril de 1997 y marzo del 2010, 687 pacientes fueron tratados por TB confirmada. Las comorbilidades mas frecuentes fueron: tabaquismo 14%; enolismo 4.8%; neoplasias 3.3%; EPOC y asma 5.6%; enfermedades hematologicas 2%; enfermedades autoinmunes 3.3%; diabetes 3%; VIH 6.5%; IRC 1.2%. El tabaquismo se presento mas frecuentemente asociado a la forma pulmonar estricta (p = 0.079), a diferencia de las enfermedades autoinmunes y hematologicas que se presentaron como formas miliares (p = 0.001) y VIH como formas mixtas (p = 0.002). La resistencia se presento mas frecuentemente en enfermedades autoinmunes (4%) y HIV (2%), sin valor significativo (p = 0.779). Del total de los pacientes, se detecto un n = 47 (6.8%) con algun tipo de resistencia a las drogas. En los ultimos 4 anos se detectaron 2 casos de XDR. No se encontro asociacion significativa entre los diferentes tipos de resistencias con la presencia de comorbilidades. Solo se registro un obito en un paciente con XDR. La presencia de tratamiento previo (p = 0.001) y las formas baciliferas (p = 0.016) fueron los factores asociados a un incremento de la resistencia.(AU) Tuberculosis is a public health problem with a higher incidence in poor countries. There are two aspects to consider: co-morbidities which are risk factors for tuberculosis, complicating its evolution and treatment, and resistance to first line drugs which is a threat to tuberculosis control. The objective of the paper was to identify the co-morbidities and the frequency of drug resistance in tuberculosis patients. The study included patients older than 16 years of age with diagnosis of tuberculosis at the Hospital de Clinicas San Jose de San Martin in Buenos Aires. The SSPS 15 program was used for the statistical analysis. From April 1997 to March 2010, 687 patients were treated for confirmed tuberculosis. The most frequent co-morbidities were: tobacco smoking habit 14%; alcoholism 4.8%; cancer 3.3%; COPD and asthma 5.6%; blood diseases 2%; autoimmune diseases 3.3%; diabetes 3%; HIV infection 6.5%; IRC 1.2%. The tobacco smoking habit was more frequently associated to pulmonary tuberculosis (p = 0.079), instead the autoimmune and blood diseases were mostly associated to miliary tuberculosis (p = 0.001) and the HIV infection to tuberculosis in several organs (p = 0.002). Drug resistance was more frequent when autoimmune diseases (4%) and HIV infection (2%) were present, but without reaching statistical significance (p = 0.779). Resistance to at least one drug was present in 47 patients (6.8%). In the last 4 years, 2 cases of extremely drug resistant tuberculosis were detected. There was no significant association between the type of drug resistance and the co-morbidities. Only one death was registered in a patient with extremely drug resistant tuberculosis. Previous treatment (p = 0.001) and sputum positive tuberculosis (p = 0.016) were factors associated to increased drug resistance.(AU)