Assuntos
Antituberculosos/uso terapêutico , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Avaliação de Resultados da Assistência ao Paciente , Tuberculose Resistente a Múltiplos Medicamentos/complicações , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Coinfecção/tratamento farmacológico , Coinfecção/microbiologia , Coinfecção/virologia , Controle de Doenças Transmissíveis/normas , Coleta de Dados , Intervalo Livre de Doença , Europa (Continente) , Alemanha , Infecções por HIV/epidemiologia , Humanos , Estimativa de Kaplan-Meier , Prevalência , Modelos de Riscos Proporcionais , Análise de Regressão , Risco , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologiaRESUMO
Drug-resistant Mycobacterium tuberculosis is challenging elimination of tuberculosis (TB). We evaluated risk factors for TB and levels of second-line drug resistance in M. tuberculosis in patients in Europe with multidrug-resistant (MDR) TB. A total of 380 patients with MDR TB and 376 patients with non-MDR TB were enrolled at 23 centers in 16 countries in Europe during 2010-2011. A total of 52.4% of MDR TB patients had never been treated for TB, which suggests primary transmission of MDR M. tuberculosis. At initiation of treatment for MDR TB, 59.7% of M. tuberculosis strains tested were resistant to pyrazinamide, 51.1% were resistant to ≥1 second-line drug, 26.6% were resistant to second-line injectable drugs, 17.6% were resistant to fluoroquinolones, and 6.8% were extensively drug resistant. Previous treatment for TB was the strongest risk factor for MDR TB. High levels of primary transmission and advanced resistance to second-line drugs characterize MDR TB cases in Europe.