Resistencia a fármacos antituberculosos de primera línea en Españna durante 2010-2011. Estudio RETUBES / Resistance to First-Line Antituberculosis Drugs in Spain, 2010-2011. RETUBES Study

Introducción: La magnitud de la resistencia actual a fármacos antituberculosos en España es desconocida. El objetivo del estudio es describir la resistencia a fármacos antituberculosos de primera línea y determinar sus factores asociados. Métodos: Estudio prospectivo multicéntrico de pacientes tuberculosos adultos con aislamiento de Mycobacterium tuberculosis y antibiograma de fármacos de primera línea en 32 hospitales y un centro extrahospitalario del sistema sanitario nacional durante los años 2010 y 2011. Resultados: Se estudió a 519 pacientes, 342 españoles y 177 (34,1%) extranjeros, 48 de ellos (9,2%) con resistencia a cualquier fármaco, de los que 35 (6,7%) eran resistentes a isoniacida. Hubo 10 casos multirresistentes (1,9%) y ninguno extremadamente resistente. Se detectó resistencia inicial a isoniacida en 28 de los 487 (5,7%) pacientes sin antecedentes de tratamiento antituberculoso previo, afectando más a los extranjeros (p < 0,01), y resistencia adquirida en 7 (22,6%) casos previamente tratados. La multirresistencia fue inicial en 6 casos (1,2%) y adquirida en otros 4 (12,9%). Los factores asociados a tener resistencia inicial a isoniacida fueron ser inmigrante y la convivencia en grupo (OR = 2,3; IC del 95%, 0,98- 5,67, y OR = 2,2; IC del 95%, 1,05-7,07, respectivamente). El factor asociado a la existencia de resistencia adquirida a isoniacida fue la edad inferior a 50 años (p = 0,03). Conclusiones: La tasa de resistencia inicial a isoniacida es superior a la estimada, probablemente debida al aumento de la inmigración durante los últimos años, lo que aconseja su vigilancia nacional sistemática. Los individuos inmigrantes y los que conviven en grupo tienen mayor riesgo de tener resistencia a isoniacida

Introduction: The magnitude of current resistance to antituberculosis drugs in Spain is unknown. The objective of this study is to describe resistance to first-line antituberculosis drugs and determine the associated factors. Methods: Prospective multicenter study of adult tuberculosis patients with positive Mycobacterium tuberculosis culture and antibiogram including first-line drugs in 32 hospitals and one out-patient center of the Spanish Health System between 2010 and 2011. Results: A total of 519 patients, 342 Spanish nationals and 177 (34.1%) foreigners were studied. Drug resistance was found in 48 (9.2%), of which 35 (6.7%) were isoniazid-resistant. There were 10 (1.9%) multiresistant cases and no strain was extremely resistant. Initial isoniazid resistance was detected in 28 of the 487 (5.7%) antituberulosis-naïve patients, most of whom were foreigners (P<.01). Acquired resistance was seen in 7 (22.6%) previously treated cases. Multiresistance was initial in 6 cases (1.2%) and acquired in another 4 (12.9%). Factors associated with initial isoniazid resistance were immigrant status and group cohabitation OR = 2.3; 95%CI: .98-5.67 and OR = 2.2; 95%CI: 1.05-7.07 respectively). The factor associated with acquired resistance to isoniazid was age below 50 years (P=.03). Conclusions: The rate of initial isoniazid resistance is greater than estimated, probably due to the increase in immigration during recent years, suggesting that systematic national monitoring is required. Immigrants and those who cohabit in groups have a higher risk of isoniazid resistance

Resistance to first-line antituberculosis drugs in Spain, 2010-2011. RETUBES Study.

INTRODUCTION: The magnitude of current resistance to antituberculosis drugs in Spain is unknown. The objective of this study is to describe resistance to first-line antituberculosis drugs and determine the associated factors. METHODS: Prospective multicenter study of adult tuberculosis patients with positive Mycobacterium tuberculosis culture and antibiogram including first-line drugs in 32 hospitals and one out-patient center of the Spanish Health System between 2010 and 2011. RESULTS: A total of 519 patients, 342 Spanish nationals and 177 (34.1%) foreigners were studied. Drug resistance was found in 48 (9.2%), of which 35 (6.7%) were isoniazid-resistant. There were 10 (1.9%) multiresistant cases and no strain was extremely resistant. Initial isoniazid resistance was detected in 28 of the 487 (5.7%) antituberulosis-naïve patients, most of whom were foreigners (P<.01). Acquired resistance was seen in 7 (22.6%) previously treated cases. Multiresistance was initial in 6 cases (1.2%) and acquired in another 4 (12.9%). Factors associated with initial isoniazid resistance were immigrant status and group cohabitation OR=2.3; 95%CI: .98-5.67 and OR=2.2; 95%CI: 1.05-7.07 respectively). The factor associated with acquired resistance to isoniazid was age below 50 years (P=.03). CONCLUSIONS: The rate of initial isoniazid resistance is greater than estimated, probably due to the increase in immigration during recent years, suggesting that systematic national monitoring is required. Immigrants and those who cohabit in groups have a higher risk of isoniazid resistance.

Diagnóstico del déficit de alfa 1-antitripsina: limitaciones de las pruebas de laboratorio de diagnóstico rápido / Diagnosis of Alpha-1 Antitrypsin Deficiency: Limitations of Rapid Diagnostic Laboratory Tests

El déficit hereditario de alfa 1-antitripsina ( 1-AT) predispone al desarrollo de enfisema pulmonar. Elobjetivo de este trabajo es evidenciar las limitaciones de algunos métodos de laboratorio utilizados en elestudio del déficit, cuya interpretación puede inducir a error en la detección de alelos poco frecuentes.Se describen dos casos clínicos: la paciente índice, que presentaba enfisema pulmonar con niveles de 1-AT inferiores a 12 mg/dL, catalogada erróneamente como homocigota de la variante alélica normalPI MM mediante un método de genotipificado rápido; la madre de la paciente, asintomática, con nivelesbajos (60 mg/dL), catalogada también como PI MM.La secuenciación del gen catalogó a la paciente índice como portadora del alelo nulo PI Clayton y deldeficitario PI Mmalton. La madre resultó portadora heterocigota PI Clayton/PI M.Los resultados ponen de relieve las dificultades de diagnóstico del déficit así como la necesidad deconsensuar métodos para este estudio(AU)

Hereditary alpha-1-antitrypsin ( 1-AT) deficiency predisposes to pulmonary emphysema. The objectiveof this study is to demonstrate the limitations of some laboratory methods used in the study of thedeficiency, and which may produce errors in interpretation and detection of uncommon alleles.Two clinical cases are described: the index patient, who had pulmonary emphysema with 1-AT levelsless than 12 mg/dL, was erroneously classified as a homozygote of the normal allelic variant PIMMusinga rapid genotype method; the mother of the patient, asymptomatic, with low levels (60 mg/dL), was alsoclassified as PI MM.The gene sequencing classified the index patient as a carrier of the PI Clayton null allele and PI Mmaltondeficient. The mother was a PI Clayton/PI heterozygote carrier.These results highlight the difficulties in diagnosing the deficiency, as the well as the need to reach aconsensus on methods for this study(AU)

[Diagnosis of alpha-1 antitrypsin deficiency: limitations of rapid diagnostic laboratory tests]. / Diagnóstico del déficit de alfa 1-antitripsina: limitaciones de las pruebas de laboratorio de diagnóstico rápido.

Hereditary alpha-1-antitrypsin (α1-AT) deficiency predisposes to pulmonary emphysema. The objective of this study is to demonstrate the limitations of some laboratory methods used in the study of the deficiency, and which may produce errors in interpretation and detection of uncommon alleles. Two clinical cases are described: the index patient, who had pulmonary emphysema with α1-AT levels less than 12 mg/dL, was erroneously classified as a homozygote of the normal allelic variant PI MM using a rapid genotype method; the mother of the patient, asymptomatic, with low levels (60 mg/dL), was also classified as PI MM. The gene sequencing classified the index patient as a carrier of the PI Clayton null allele and PI Mmalton deficient. The mother was a PI Clayton/PI heterozygote carrier. These results highlight the difficulties in diagnosing the deficiency, as the well as the need to reach a consensus on methods for this study.

Diagnóstico y tratamiento de la tuberculosis / No disponible

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