Factores de riesgo asociados a la farmacorresistencia y al tratamiento no exitoso de la tuberculosis en Chile 2014-2018 / Risk factors and predictors of drug resistance in tuberculosis: A comprehensive analysis of cases in Chile (2014-2018)

RESUMEN

OBJETIVOS: Determinar los factores de riesgos asociados a la farmacorresistencia y al tratamiento no exitoso de tuberculosis en Chile durante el 20142018. METODOLOGÍA: Estudio transversal observacional analítico que incluye los pacientes notificados con tuberculosis (TB) que ingresaron a tratamiento durante el 2014-2018 en Chile, contenidos en el registro nacional TB. Se determinaron variables demográficas, clínicas y grupos de riesgos asociados a la farmacorresistencia y al tratamiento no exitoso en pacientes con TB mediante regresión logística. RESULTADOS: Entre los años 2014-2018 se notificaron 13.1761 pacientes con TB en Chile, de los cuales 3,4% (n = 445) son farmacorresistentes. El 43,1% de estos son TB resistente a rifampicina (TB-RR), multidrogorresistente (TB-MDR) y extensamente resistente (TB-XDR). Los factores de riesgo que generaron mayor probabilidad de presentar farmacorresistencia fueron la recaída (OR 4,27; IC 95% 2,94; 6,20), extranjero (OR 3,97; IC 95% 2,86; 5,52), TB pulmonar (OR 2,92; IC 95% 1,71; 4,99) y VIH (OR 1,97; IC 95% 1,33; 2,90). Frente a la probabilidad de generar un tratamiento no exitoso, las variables que presentaron mayor probabilidad fueron situación de calle (OR 3,33; IC 95% 2,45; 4,52), drogadicción (OR 1,91; IC 95% 1,52; 2,41), extranjero (OR 1,51; IC 95% 1,25; 1,83), farmacorresistencia (OR 2,81; IC 95% 1,87; 4,20), VIH (OR 3,24; IC 95% 2,61; 4,02), no pertenecer a un pueblo indígena (OR 1,43; IC 95% 1,00; 2,06) alcoholismo (OR 1,25; IC 95% 1,01; 1,54), TB pulmonar (OR 1,43; IC 95% 1,20; 1,70) y sexo masculino (OR 1,44; IC 95% 1,25; 1,65). CONCLUSIONES: Los factores de riesgo identificados como la recaída y la coinfección con VIH como predictores de farmacorresistencia destaca la complejidad del manejo de la enfermedad. Asimismo, la presencia de situaciones de calle, drogadicción y alcoholismo resalta la necesidad de enfoques específicos y personalizados para abordar la tuberculosis en distintos grupos poblacionales. Estos resultados subrayan la importancia de abordar estos factores de riesgo en la gestión y tratamiento de la tuberculosis en Chile, sugiriendo la necesidad de estrategias específicas y personalizadas.

ABSTRACT

OBJECTIVE: Determine the risk factors associated with drug resistance and unsuccessful treatment of tuberculosis in Chile between 2014 and 2018. METHODOLOGY: Analytical observational cross-sectional study including patients diagnosed with Tuberculosis (TB) who entered treatment during 2014-2018, contained in the national TB records. Demographic, clinical variables, and risk groups associated with drug resistance and unsuccessful treatment in TB patients were determined using logistic regression. RESULTS: Between 2014 and 2018, 13,1761 TB patients were reported in Chile, of whom 3.4% (n = 445) were drug-resistant. From this, 43.1% are rifampicin-resistant TB (RR-TB), multidrug-resistant (MDR-TB), and extensively drug-resistant (XDR-TB). The risk factors that generated the highest probability of drug resistance were relapse (OR 4.27; CI95% 2.94; 6.20), foreigner (OR 3.97; CI95% 2.86; 5.52), pulmonary TB (OR 2.92; CI95% 1.71; 4.99) and HIV (OR 1.97; CI 95% 1.33; 2.90). Regarding the probability of unsuccessful treatment against TB, the highest probability were street situation (OR 3.33; CI 95% 2.45; 4.52), drug addiction (OR 1.91; CI 95% 1.52; 2.41), foreigner (OR 1.51; CI 95% 1.25; 1.83), drug resistance (OR 2.81; CI 95% 1.87; 4.20), HIV (OR 3.24; CI 95% 2.61; 4.02), not belonging to an indigenous people (OR 1.43; CI 95% 1.00; 2.06) alcoholism (OR 1.25; CI 95% 1.01; 1.54), pulmonary TB (OR 1.43; CI 95% 1.20; 1.70) and male sex (OR 1.44; CI 95% 1.25; 1.65). CONCLUSIONS: The risk factors identified as relapse and coinfection with HIV as predictors of drug resistance highlight the complexity of disease management. Likewise, the presence of street situations, drug addiction, and alcoholism highlights the need for specific approaches to address tuberculosis in different population groups, suggesting the need for personalized strategies.