Resistencias de Mycobacterium tuberculosis en el área del Hospital de Sagunto desde 1999 al 2004 / Anti-tuberculosis drug resistance of Mycobacterium tuberculosis in the area of the Hospital de Sagunto from 1999 to 2004

Objetivo. La finalidad del estudio fue conocer los patrones de sensibilidad a antimicrobianos de Mycobacterium tuberculosis, en particular la resistencia primaria a isoniacida, en el área del Hospital de Sagunto, así como estudiar las características clínicas y factores de riesgo asociadas a los mismos. Material y métodos. Se incluyeron todos los pacientes con diagnóstico de tuberculosis desde enero de 1999 a diciembre de 2004, en los que se aislaron cepas de M. tuberculosis en cultivo de una muestra clínica y se realizó estudio de resistencias a los fármacos antituberculosos de primera línea. Se recogieron de la historia clínica los factores de riesgo y las características clínicas de los pacientes. Resultados. El total de cepas aisladas fue de 77, con una tasa global de resistencias del 14,1%. La frecuencia de resistencias primarias fue del 12%, siendo las secundarias del 27%. No se detectó ningún caso de multirresistencia. Las resistencias primarias fueron: 3% a isoniacida, 3% a rifampicina, 3% a piracinamida, 4,5% a etambutol y 3% a estreptomicina. La resistencia adquirida fue del 9,1% para isoniacida y del 27% para estreptomicina, no encontrando resistencias para el resto de los fármacos testados. Conclusiones. La baja frecuencia de resistencias primarias a isoniacida hace que podamos tratar los casos nuevos en población autóctona con tres fármacos. Los factores de riesgo asociados a resistencias en nuestra área fueron el tabaquismo y el alcoholismo. Aunque todos los pacientes con resistencias presentaban formas pulmonares, las diferencias no fueron estadísticamente significativas, y sí lo fue la mayor frecuencia de derrame pleural en pacientes con resistencias (AU)

Objectives. This study aimed to know the drug resistance patterns of Mycobacterium tuberculosis, specifically primary drug resistance to isoniazid, in the area of the Hospital de Sagunto and to study the clinical characteristics and the risk factors associated with them. Material and methods. Patients included were those who were diagnosed of tuberculosis and whose M. tuberculosis strains were isolated in culture of a clinical sample and in whom a susceptibility test against the first line anti-tuberculosis drugs was performed from January 1999 to December 2004. Risk factors and clinical characteristics of the patients were gathered from the case- history. Results. The total number of strains isolated was 77 and the global rate of resistance was 14.1%. Rate of primary drug resistance was 12.1%, and acquired 27%. No multidrug resistant case was detected. Primary drug resistance was 3% to isoniazid, 3% to rifampin, 3% to pyrazinamid, 4.5% to ethambutol and 3% to streptomycin. Acquired drug resistance was 9.1% against isoniazid and 27% against streptomicin, no resistance against the other drugs tested being found. Conclusions. The low level of primary drug resistance against isoniazid allows us to start treatment with three-drug regimes in new cases of native population. In our hospital area, the risk factors associated with drug resistances were smoking habit and alcoholism. Although all patients with drug resistance presented pulmonary disease, the differences were not statistically significant. However, the higher rate of pleural effusion in patients with drug resistance was statistically significant (AU)

[Anti-tuberculosis drug resistance of Mycobacterium tuberculosis in the area of the Hospital de Sagunto from 1999 to 2004]. / Resistencias de Mycobacterium tuberculosis en el área del Hospital de Sagunto desde 1999 al 2004.

OBJECTIVES: This study aimed to know the drug resistance patterns of Mycobacterium tuberculosis, specifically primary drug resistance to isoniazid, in the area of the Hospital de Sagunto and to study the clinical characteristics and the risk factors associated with them. MATERIAL AND METHODS: Patients included were those who were diagnosed of tuberculosis and whose M. tuberculosis strains were isolated in culture of a clinical sample and in whom a susceptibility test against the first line anti-tuberculosis drugs was performed from January 1999 to December 2004. Risk factors and clinical characteristics of the patients were gathered from the case- history. RESULTS: The total number of strains isolated was 77 and the global rate of resistance was 14.1%. Rate of primary drug resistance was 12.1%, and acquired 27%. No multidrug resistant case was detected. Primary drug resistance was 3% to isoniazid, 3% to rifampin, 3% to pyrazinamid, 4.5% to ethambutol and 3% to streptomycin. Acquired drug resistance was 9.1% against isoniazid and 27% against streptomicin, no resistance against the other drugs tested being found. CONCLUSIONS: The low level of primary drug resistance against isoniazid allows us to start treatment with three-drug regimes in new cases of native population. In our hospital area, the risk factors associated with drug resistances were smoking habit and alcoholism. Although all patients with drug resistance presented pulmonary disease, the differences were not statistically significant. However, the higher rate of pleural effusion in patients with drug resistance was statistically significant.

[Multiple nosocomial infections. An incidence study]. / Infecciones nosocomiales múltiples. Un estudio de incidencia.

BACKGROUND: Some studies point out that around 30%-50% of the nosocomial infections (NI) are multiple (MNI) and are found in 21%-30% of the patients with NI. The significance of these data and their potential consequences have led the authors to perform this study. PATIENTS AND METHODS: A longitudinal descriptive study was carried out on the incidence and characteristics of NI (MNI and single nosocomial infection [SNI]) in 26,977 patients admitted to a county hospital from 1991 to 1993. RESULTS: NI was detected in 1,246 patients with 31% presenting MNI appearing in 15% of the patients. MNI predominated in males, had a mean age were 5 to 12 years higher than the patients with SNI with a mean hospital stay of between 13-28 days more than the SNI group. The MNI were significantly less frequent in the Urology, Gynecology and Obstetrics Departments and were more frequent in the Intensive Care Unit. The localization of the infection varied significantly among the patients with one or several infections. Bacteremia, pneumonia and soft tissue infections were significantly more frequent in MNI patients. CONCLUSIONS: Multiple nosocomial infections are frequent and their basic characteristics are significantly different from those of single nosocomial infections. The patients who acquire SNI should be carefully followed to avoid the appearance of MNI.