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1.
Arch Bronconeumol ; 2020 Jun 10.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32534870

RESUMO

INTRODUCTION: The diagnosis of latent tuberculous infection (LTI) by IGRA continues to generate debate. Experience in the simultaneous use of 2 IGRA tests is scant. The aim of this study was to compare the results of 2 versions of QuantiFERON-TB Gold (In-Tube/Plus) with those of T-SPOT.TB, and to analyse the effectiveness of a dual strategy (T-SPOT.TB + QTF) for the diagnosis of LTI in an immunosuppressed population. METHODS: We conducted a prospective study (May 2015-June 2017) that included 2,999 immunosuppressed patients and/or candidates for biologics, in whom 2 simultaneous IGRA tests were performed: Group 1 (1535 patients): T-SPOT.TB + QuantiFERON-TB Gold-In-Tube (QTF-GIT); Group 2 (1464 patients): T-SPOT.TB + QuantiFERON-TB Gold Plus (QTF-Plus). RESULTS: The concordance between QTF-GIT and T-SPOT.TB was 83.19% (κ=0.532). The percentage of positive, negative, and indeterminate results were, respectively: 14.33% vs. 17.06%; 82.41% vs. 74.46%; and 3.25% vs. 8.46%. The concordance between QTF-Plus and T-SPOT.TB was 87.56% (κ=0.609). The percentage of positive, negative, and indeterminate results were, respectively: 15.02% vs. 15.36%; 82.92% vs. 79.37%; and 2.04% vs. 5.25%. Discrepancies between T-SPOT.TB and QTF-Plus were 12.43%, suggesting that 103 patients were positive and another 79 were negative due exclusively to 1 of the 2 IGRAs. CONCLUSIONS: Greater concordance was found between QTF-Plus and T-SPOT.TB than between QTF-GIT and T-SPOT.TB. However, we believe that the proportion of discrepancies between T-SPOT.TB and QTF-Plus is sufficiently important from a clinical point of view to justify the simultaneous use of 2 IGRA in this specific patient group.

3.
Eur Respir J ; 56(1)2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32457198
4.
Arch Bronconeumol ; 56(8): 514-521, 2020 Aug.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32446667

RESUMO

New evidence and knowledge about the clinical management of drug-resistant tuberculosis (TB) in the last 3 years, makes it necessary to update the recent guideline published by SEPAR in 2017, mainly in relation to new diagnostic methods, drug classification, and regimens of treatment recommended to treat patients with isoniazid-resistance TB, rifampicin resistance TB and multidrug-resistant TB. With respect to tuberculosis diagnosis, we recommend the use of rapid molecular assays that also help to detect mutations associated with resistance. In relation to the treatment of multidrug-resistant TB we prioritize effective all-oral shorter treatment regimens including bedaquiline, a fluoroquinolone (levofloxacin or moxifloxacin), bedaquiline and linezolid, instead of the previously recommended short-course treatment with aminoglycosides and other less effective and more toxic drugs. The design of these regimens (initial schedule and changes in the regimen if necessary) should be made in accordance with drug-resistant TB experts; the treatment should be the responsibility of personnel with experience in the treatment of TB and in TB units guaranteeing the follow-up of the treatment and the management of drugs adverse effects.

6.
Arch Bronconeumol ; 56(2): 90-98, 2020 02.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31171411

RESUMO

INTRODUCTION: Well-coordinated multidisciplinary teams are essential for better tuberculosis (TB) control. Our objective was to evaluate the impact of Spanish Society of Pneumology (SEPAR) accreditation of TB Units (TBU) and to determine differences between the accredited and non-accredited centers. DESIGN: Observational descriptive study based on a self-administered survey from October 2014 to February 2018 completed by 139 heads of respiratory medicine departments collected by SEPAR, before and after TBU accreditation. VARIABLES: demographic, epidemiological and contact tracing (CT) variables, among others. ANALYSIS: basic descriptive analysis, and calculation of medians for continuous variables and proportions for categorical variables. The variables were compared using the Chi-squared test and logistic regression. RESULTS: The response rate was 54.7% and 43.2% in the pre- and post-TBU accreditation period, respectively. No differences were observed in the care and coordination variables between the pre- and post-accreditation survey, nor in the organization when only accredited centers were analyzed. When we compared the accredited and non-accredited centers, significant differences were detected in the collection of the final conclusion, management of resistance, coordination with other departments, contact tracing, and directly observed treatment. CONCLUSIONS: The approach of different professionals with regard to TB has been addressed. Positive aspects and areas for improvement have been detected, and better results were observed in the accredited versus non-accredited centers. A closer supervision of TBUs is necessary to improve their effectiveness.

7.
Arch Bronconeumol ; 2019 Nov 25.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31780285

RESUMO

OBJECTIVE: The objective of the study was to determine the trend of variables related to tuberculosis (TB) from the Integrated Tuberculosis Research Program (PII-TB) registry of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR), and to evaluate the PII-TB according to indicators related to its scientific objectives. METHOD: Cross-sectional, population-based, multicenter study of new TB cases prospectively registered in the PII-TB between 2006 and 2016. The time trend of quantitative variables was calculated using a lineal regression model, and qualitative variables using the χy test for lineal trend. RESULTS: A total of 6,892 cases with an annual median of 531 were analyzed. Overall, a significant downward trend was observed in women, immigrants, prisoners, and patients initially treated with 3 drugs. Significant upward trends were observed in patients aged 40-50 and > 50 years, first visit conducted by a specialist, hospitalization, diagnostic delay, disseminated disease and single extrapulmonary location, culture(+), sensitivity testing performed, drug resistance, directly observed treatment, prolonged treatment, and death from another cause. The scientific objectives of the PII-TB that showed a significant upward trend were publications, which reached a maximum of 8 in 2016 with a total impact factor of 49,664, numbers of projects initiated annually, presentations at conferences, and theses. CONCLUSIONS: PII-TB provides relevant information on TB and its associated factors in Spain. A large team of researchers has been created; some scientific aspects of the registry were positive, while others could have been improved.

8.
Eur Respir J ; 54(6)2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31601711

RESUMO

The World Health Organization (WHO) recommends that countries implement pharmacovigilance and collect information on active drug safety monitoring (aDSM) and management of adverse events.The aim of this prospective study was to evaluate the frequency and severity of adverse events to anti-tuberculosis (TB) drugs in a cohort of consecutive TB patients treated with new (i.e. bedaquiline, delamanid) and repurposed (i.e. clofazimine, linezolid) drugs, based on the WHO aDSM project. Adverse events were collected prospectively after attribution to a specific drug together with demographic, bacteriological, radiological and clinical information at diagnosis and during therapy. This interim analysis included patients who completed or were still on treatment at time of data collection.Globally, 45 centres from 26 countries/regions reported 658 patients (68.7% male, 4.4% HIV co-infected) treated as follows: 87.7% with bedaquiline, 18.4% with delamanid (6.1% with both), 81.5% with linezolid and 32.4% with clofazimine. Overall, 504 adverse event episodes were reported: 447 (88.7%) were classified as minor (grade 1-2) and 57 (11.3%) as serious (grade 3-5). The majority of the 57 serious adverse events reported by 55 patients (51 out of 57, 89.5%) ultimately resolved. Among patients reporting serious adverse events, some drugs held responsible were discontinued: bedaquiline in 0.35% (two out of 577), delamanid in 0.8% (one out of 121), linezolid in 1.9% (10 out of 536) and clofazimine in 1.4% (three out of 213) of patients. Serious adverse events were reported in 6.9% (nine out of 131) of patients treated with amikacin, 0.4% (one out of 221) with ethionamide/prothionamide, 2.8% (15 out of 536) with linezolid and 1.8% (eight out of 498) with cycloserine/terizidone.The aDSM study provided valuable information, but implementation needs scaling-up to support patient-centred care.

9.
Int J Infect Dis ; 83: 72-76, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30953827

RESUMO

The World Health Organization launched a global initiative, known as aDSM (active TB drug safety monitoring and management) to better describe the safety profile of new treatment regimens for drug-resistant tuberculosis (TB) in real-world settings. However, comprehensive surveillance is difficult to implement in several countries. The aim of the aDSM project is to demonstrate the feasibility of implementing national aDSM registers and to describe the type and the frequency of adverse events (AEs) associated with exposure to the new anti-TB drugs. Following a pilot study carried out in 2016, official involvement of TB reference centres/countries into the project was sought and cases treated with bedaquiline- and/or delamanid-containing regimens were consecutively recruited. AEs were prospectively collected ensuring potential attribution of the AE to a specific drug based on its known safety profile. A total of 309 cases were fully reported from 41 centres in 27 countries (65% males; 268 treated with bedaquiline, 20 with delamanid, and 21 with both drugs) out of an estimated 781 cases the participating countries had committed to report by the first quarter of 2019.


Assuntos
Antituberculosos/efeitos adversos , Diarilquinolinas/efeitos adversos , Nitroimidazóis/efeitos adversos , Oxazóis/efeitos adversos , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Diarilquinolinas/administração & dosagem , Quimioterapia Combinada , Estudos de Viabilidade , Feminino , Humanos , Masculino , Nitroimidazóis/administração & dosagem , Oxazóis/administração & dosagem , Projetos Piloto , Tuberculose/tratamento farmacológico , Organização Mundial da Saúde
12.
Arch. bronconeumol. (Ed. impr.) ; 53(10): 554-560, oct. 2017. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-167422

RESUMO

Introducción y objetivo: Los aislamientos de micobacterias no tuberculosas (MNT) son cada vez más frecuentes. El objetivo principal de nuestro estudio fue conocer el número y la variedad de especies de MNT en nuestra región, su distribución según el origen de la muestra, y la edad y sexo de los pacientes; asimismo, analizar pormenorizadamente los aislamientos clínicamente significativos. Metodología: Estudio prospectivo que incluye todas las MNT aisladas en Asturias durante el período 2005-2012. Las muestras se procesaron siguiendo directrices internacionalmente aceptadas. Para el tratamiento estadístico de los datos se utilizaron tablas de contingencia 2 × 2 aplicando el test exacto de Fisher. Resultados: Se aislaron 3.284 micobacterias: 1.499 Mycobacterium tuberculosis complex (MTB) y 1.785 MNT. A lo largo del estudio se incrementaron los aislamientos de MNT y se redujeron los de MTB. Los aislamientos de MNT fueron más numerosos en hombres que en mujeres (p <0,001). M. gordonae, la especie más frecuentemente aislada, no originó enfermedad en ningún caso. El aislamiento fue clínicamente significativo en 212 pacientes (17,1%), siendo M. kansasii y M. avium las especies que más frecuentemente causaron enfermedad. La diferencia de aislamientos de M. kansasii entre mujeres y hombres fue estadísticamente significativa (p < 0,01). Conclusiones: En nuestro estudio, los aislamientos de MNT se incrementaron un 35%, frente a un descenso del 21% de los casos de MTB. Tanto los aislamientos de MNT como los casos clínicamente significativos fueron más frecuentes en hombres. Solo un 17,1% de las MNT aisladas, principalmente M. avium complex (MAC) y M. kansasii, ocasionaron enfermedad


Introduction and objective: Non-tuberculous mycobacteria (NTM) isolates are becoming more common. The main objective of our study was to establish the number and diversity of NTM species in our region and their distribution according to the source sample, age and gender of the patients, and to analyse clinically significant isolates. Methodology: Prospective study of all NTM isolated in Asturias from 2005 to 2012. Samples were processed following internationally accepted guidelines. Statistical analysis was based on Fisher's exact test for 2 × 2 contingency tables. Results: A total of 3,284 mycobacteria were isolated: 1,499 Mycobacterium tuberculosis complex (MTB) and 1,785 NTM. During the study, NTM isolation rates increased while MTB isolation decreased. NTM were more frequent in men (P < .001). M. gordonae was the most frequently isolated species but did not cause disease in any case. NTM isolates from 212 patients were associated with clinically significant disease (17.1%). M. kansasii and M. avium were most commonly associated with disease. The number of M. kansasii isolates from men was statistically significant (P < .01). Conclusions: In our study, NTM isolates increased by 35%, compared with a 21% decline in cases of MTB. Both isolation of NTM and clinically significant cases were more common in men. Only 17.1% of NTM isolates were associated with disease, most commonly M. avium complex and M. kansasii


Assuntos
Humanos , Mycobacterium/isolamento & purificação , Infecções por Mycobacterium não Tuberculosas/epidemiologia , Micobactérias não Tuberculosas/patogenicidade , Estudos Prospectivos , Infecções por Mycobacterium/epidemiologia , Doenças Transmissíveis Emergentes/epidemiologia , Mycobacterium kansasii/patogenicidade , Mycobacterium avium/patogenicidade , Mycobacterium tuberculosis/patogenicidade
13.
Arch. bronconeumol. (Ed. impr.) ; 53(9): 501-509, sept. 2017. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-166280

RESUMO

En las últimas 2 décadas la tuberculosis con resistencia a fármacos se ha convertido en una amenaza y un reto para la salud pública mundial. El diagnóstico y el tratamiento de estas formas de tuberculosis es mucho más complejo, y el pronóstico empeora claramente a medida que se incrementa el patrón de las resistencias. Sin embargo, es necesario destacar cómo con el manejo clínico y programático adecuado de estos enfermos se puede conseguir la curación de una mayoría de ellos. En esta normativa se razonan las bases del diagnóstico y tratamiento de todos los pacientes afectos de tuberculosis, desde aquellos que tienen formas de la enfermedad con sensibilidad a todos los fármacos hasta aquellos que son portadores de los patrones más extensos de resistencia. Asimismo, se dan recomendaciones específicas para cada uno de estos supuestos. También se aborda el papel que ya están teniendo y pueden tener en un futuro inmediato los nuevos métodos moleculares de detección de resistencias, los esquemas acortados de tratamiento de la tuberculosis multi-farmacorresistente (TB-MDR) y los nuevos fármacos con actividad frente a Mycobacterium tuberculosis (AU)


In the last 2 decades, drug-resistant tuberculosis has become a threat and a challenge to worldwide public health. The diagnosis and treatment of these forms of tuberculosis are much more complex and prognosis clearly worsens as the resistance pattern intensifies. Nevertheless, it is important to remember that with the appropriatesystematic clinical management, most of these patients can be cured. These guidelines itemize the basis for the diagnosis and treatment of all tuberculosis patients, from those infected by strains that are sensitive to all drugs, to those who are extensively drug-resistant. Specific recommendations are given forall cases. The current and future role of new molecular methods for detecting resistance, shorter multi-drug-resistant tuberculosis regimens, and new drugs with activity against Mycobacterium tuberculosis are also addressed (AU)


Assuntos
Humanos , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Padrões de Prática Médica , Testes de Sensibilidade Microbiana , Mycobacterium tuberculosis/patogenicidade , Fatores de Risco , Técnicas de Diagnóstico Molecular
14.
Eur Respir J ; 49(5)2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28529205

RESUMO

Large studies on bedaquiline used to treat multidrug-resistant (MDR-) and extensively drug-resistant tuberculosis (XDR-TB) are lacking. This study aimed to evaluate the safety and effectiveness of bedaquiline-containing regimens in a large, retrospective, observational study conducted in 25 centres and 15 countries in five continents.428 culture-confirmed MDR-TB cases were analysed (61.5% male; 22.1% HIV-positive, 45.6% XDR-TB). MDR-TB cases were admitted to hospital for a median (interquartile range (IQR)) 179 (92-280) days and exposed to bedaquiline for 168 (86-180) days. Treatment regimens included, among others, linezolid, moxifloxacin, clofazimine and carbapenems (82.0%, 58.4%, 52.6% and 15.3% of cases, respectively).Sputum smear and culture conversion rates in MDR-TB cases were 63.6% and 30.1%, respectively at 30 days, 81.1% and 56.7%, respectively at 60 days; 85.5% and 80.5%, respectively at 90 days and 88.7% and 91.2%, respectively at the end of treatment. The median (IQR) time to smear and culture conversion was 34 (30-60) days and 60 (33-90) days. Out of 247 culture-confirmed MDR-TB cases completing treatment, 71.3% achieved success (62.4% cured; 8.9% completed treatment), 13.4% died, 7.3% defaulted and 7.7% failed. Bedaquiline was interrupted due to adverse events in 5.8% of cases. A single case died, having electrocardiographic abnormalities that were probably non-bedaquiline related.Bedaquiline-containing regimens achieved high conversion and success rates under different nonexperimental conditions.


Assuntos
Antituberculosos/uso terapêutico , Diarilquinolinas/uso terapêutico , Tuberculose Extensivamente Resistente a Medicamentos/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Adulto , Carbapenêmicos/uso terapêutico , Clofazimina/uso terapêutico , Estudos de Coortes , Quimioterapia Combinada , Feminino , Infecções por HIV/complicações , Humanos , Linezolida/uso terapêutico , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Estudos Retrospectivos , Escarro/metabolismo , Resultado do Tratamento
15.
Arch Bronconeumol ; 53(10): 554-560, 2017 Oct.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28433210

RESUMO

INTRODUCTION AND OBJECTIVE: Non-tuberculous mycobacteria (NTM) isolates are becoming more common. The main objective of our study was to establish the number and diversity of NTM species in our region and their distribution according to the source sample, age and gender of the patients, and to analyse clinically significant isolates. METHODOLOGY: Prospective study of all NTM isolated in Asturias from 2005 to 2012. Samples were processed following internationally accepted guidelines. Statistical analysis was based on Fisher's exact test for 2×2 contingency tables. RESULTS: A total of 3,284 mycobacteria were isolated: 1,499 Mycobacterium tuberculosis complex (MTB) and 1,785 NTM.During the study, NTM isolation rates increased while MTB isolation decreased. NTM were more frequent in men (P<.001). M.gordonae was the most frequently isolated species but did not cause disease in any case. NTM isolates from 212 patients were associated with clinically significant disease (17.1%). M.kansasii and M.avium were most commonly associated with disease. The number of M.kansasii isolates from men was statistically significant (P<.01). CONCLUSIONS: In our study, NTM isolates increased by 35%, compared with a 21% decline in cases of MTB. Both isolation of NTM and clinically significant cases were more common in men. Only 17.1% of NTM isolates were associated with disease, most commonly M.avium complex and M.kansasii.


Assuntos
Doenças Transmissíveis Emergentes/epidemiologia , Infecções por Mycobacterium não Tuberculosas/epidemiologia , Micobactérias não Tuberculosas/isolamento & purificação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Técnicas de Tipagem Bacteriana , Criança , Pré-Escolar , Doenças Transmissíveis Emergentes/microbiologia , Fezes/microbiologia , Feminino , Hospitais Públicos , Humanos , Lactente , Linfonodos/microbiologia , Masculino , Pessoa de Meia-Idade , Infecções por Mycobacterium não Tuberculosas/microbiologia , Micobactérias não Tuberculosas/classificação , Estudos Prospectivos , Sistema Respiratório/microbiologia , Pele/microbiologia , Espanha/epidemiologia , Especificidade da Espécie , Urina/microbiologia , Adulto Jovem
16.
Arch Bronconeumol ; 53(9): 501-509, 2017 Sep.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28359606

RESUMO

In the last 2 decades, drug-resistant tuberculosis has become a threat and a challenge to worldwide public health. The diagnosis and treatment of these forms of tuberculosis are much more complex and prognosis clearly worsens as the resistance pattern intensifies. Nevertheless, it is important to remember that with the appropriatesystematic clinical management, most of these patients can be cured. These guidelines itemize the basis for the diagnosis and treatment of all tuberculosis patients, from those infected by strains that are sensitive to all drugs, to those who are extensively drug-resistant. Specific recommendations are given forall cases. The current and future role of new molecular methods for detecting resistance, shorter multi-drug-resistant tuberculosis regimens, and new drugs with activity against Mycobacterium tuberculosis are also addressed.


Assuntos
Antituberculosos/uso terapêutico , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Antituberculosos/classificação , Antituberculosos/farmacologia , Busca de Comunicante , Gerenciamento Clínico , Quimioterapia Combinada , Tuberculose Extensivamente Resistente a Medicamentos/diagnóstico , Tuberculose Extensivamente Resistente a Medicamentos/tratamento farmacológico , Técnicas de Genotipagem , Humanos , Testes de Sensibilidade Microbiana , Mycobacterium tuberculosis/efeitos dos fármacos , Mycobacterium tuberculosis/genética , Guias de Prática Clínica como Assunto , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia
17.
Arch. bronconeumol. (Ed. impr.) ; 53(4): 192-198, abr. 2017. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-161773

RESUMO

Objetivo: Conocer la utilidad de las técnicas moleculares para el diagnóstico de resistencias y la situación de las resistencias a fármacos de primera línea en nuestra área geográfica. Material y método: Desde 2004 a 2013, 1.889 cepas de Mycobacterium tuberculosis complex aisladas en Asturias, España, fueron estudiadas mediante pruebas de sensibilidad fenotípicas (directrices del Clinical and Laboratory Standards Institute) y moleculares (INNOLiPA RIF-TB©; GenotypeMDRplus©; GenotypeMDRsl©). Resultados: Mil setecientas cincuenta y nueve cepas (94,52%) eran sensibles a todos los fármacos de primera línea y 102 cepas (5,48%) presentaban alguna resistencia: 81 cepas (4,35%) a un solo fármaco, 14 (0,75%) con polirresistencia y 7 (0,37%) multirresistentes (resistencia a rifampicina e isoniacida). En total hubo 137 resistencias a fármacos: 60 a isoniacida (3,22%), 7 a rifampicina (0,37%), 9 a pirazinamida (0,48%), 11 a etambutol (0,59%) y 50 a estreptomicina (2,68%). El 75,9% de las mutaciones detectadas (63/83) se correlacionaron con resistencia; mientras que un 24,09% de las mutaciones detectadas (20/83) no implicaban resistencia, correspondiendo 16 a una mutación silente en el codón 514 del gen rpoB. Entre un 0 y un 90% de cepas, dependiendo del fármaco que se considere, eran resistentes aunque no presentaban mutaciones en los genes incluidos en los sistemas comerciales. Conclusiones: Las técnicas moleculares resultan muy útiles sobre todo por la rapidez en la obtención de resultados, aunque estos deben confirmarse con las pruebas de sensibilidad fenotípicas de referencia. La tasa de resistencias a fármacos en nuestra región es baja y los casos de multirresistencia (0,37%) son esporádicos


Objective: To determine the utility of molecular techniques in the diagnosis of resistance and the extent of resistance to first-line drugs in our region. Material and method: From 2004 to 2013, 1,889 strains of Mycobacterium tuberculosis complex isolated in Asturias, Spain, were studied using phenotypic (Clinical and Laboratory Standards Institute guidelines) and molecular (INNOLiPA RIF-TB©; GenotypeMDRplus©; GenotypeMDRsl©) sensitivity tests. Results: 1,759 strains (94.52%) were sensitive to all first-line drugs, and 102 strains (5.48%) showed some resistance: 81 strains (4.35%) were resistant to 1 single drug, 14 (0.75%) were polyresistant, and 7 (0.37%) were multiresistant (resistant to rifampicin and isoniazid). In total, 137 resistances were identified: 60 to isoniazid (3.22%), 7 to rifampicin (0.37%), 9 to pyrazinamide (0.48%), 11 to ethambutol (0.59%), and 50 to streptomycin (2.68%). Of the mutations detected, 75.9% (63/83) correlated with resistance, while 24.09% of mutations detected (20/83) were not associated with resistance; 16 of these involved a silent mutation at codon 514 of the rpoB gene. Between 0 and 90% of strains, depending on the drug under consideration, were resistant even when no gene mutations were detected using marketed systems. Conclusions: Molecular techniques are very useful, particularly for obtaining rapid results, but these must be confirmed with standard phenotypic sensitivity testing. The rate of resistance in our region is low and multi-drug resistant cases (0.37%) are sporadic


Assuntos
Humanos , Fenótipo , Técnicas de Genotipagem , Mycobacterium tuberculosis , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Resistência Microbiana a Medicamentos , Antibióticos Antituberculose/uso terapêutico , Testes de Sensibilidade Microbiana/estatística & dados numéricos , Técnicas de Diagnóstico Molecular/métodos , Distribuição por Idade e Sexo , Estudos Prospectivos
18.
Arch Bronconeumol ; 53(4): 192-198, 2017 Apr.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28277228

RESUMO

OBJECTIVE: To determine the utility of molecular techniques in the diagnosis of resistance and the extent of resistance to first-line drugs in our region. MATERIAL AND METHOD: From 2004 to 2013, 1,889 strains of Mycobacterium tuberculosis complex isolated in Asturias, Spain, were studied using phenotypic (Clinical and Laboratory Standards Institute guidelines) and molecular (INNOLiPA RIF-TB©; GenotypeMDRplus©; GenotypeMDRsl©) sensitivity tests. RESULTS: 1,759 strains (94.52%) were sensitive to all first-line drugs, and 102 strains (5.48%) showed some resistance: 81 strains (4.35%) were resistant to 1 single drug, 14 (0.75%) were polyresistant, and 7 (0.37%) were multiresistant (resistant to rifampicin and isoniazid). In total, 137 resistances were identified: 60 to isoniazid (3.22%), 7 to rifampicin (0.37%), 9 to pyrazinamide (0.48%), 11 to ethambutol (0.59%), and 50 to streptomycin (2.68%). Of the mutations detected, 75.9% (63/83) correlated with resistance, while 24.09% of mutations detected (20/83) were not associated with resistance; 16 of these involved a silent mutation at codon 514 of the rpoB gene. Between 0 and 90% of strains, depending on the drug under consideration, were resistant even when no gene mutations were detected using marketed systems. CONCLUSIONS: Molecular techniques are very useful, particularly for obtaining rapid results, but these must be confirmed with standard phenotypic sensitivity testing. The rate of resistance in our region is low and multi-drug resistantcases (0.37%) are sporadic.


Assuntos
Antituberculosos/farmacologia , Mycobacterium tuberculosis/efeitos dos fármacos , Mycobacterium tuberculosis/genética , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Farmacorresistência Bacteriana , Feminino , Genótipo , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Fenótipo , Estudos Prospectivos , Adulto Jovem
19.
Arch. bronconeumol. (Ed. impr.) ; 52(12): 583-589, dic. 2016. tab, mapa
Artigo em Espanhol | IBECS | ID: ibc-158380

RESUMO

Objetivo. Analizar los costes directos e indirectos derivados del diagnóstico y tratamiento de la tuberculosis (TB) y sus factores asociados. Pacientes y métodos. Estudio prospectivo de pacientes diagnosticados de TB entre septiembre de 2014 y septiembre de 2015. Se calcularon los costes directos (estancias hospitalarias, consultas, estudios diagnósticos y tratamiento), e indirectos (absentismo laboral y pérdida de productividad, estudio de contactos y medidas rehabilitadoras). Los costes se compararon atendiendo a las variables: edad, sexo, país de origen, ingreso hospitalario, pruebas diagnósticas, tratamiento, resistencia farmacológica, tratamiento directamente observado (TDO) y días de baja laboral. Se compararon proporciones mediante Chi cuadrado y las variables significativas se incluyeron en un modelo de regresión logística calculándose las odds ratio (OR) y sus correspondientes intervalos de confianza del 95% (IC). Resultados. Fueron incluidos 319 pacientes con una edad media de 56,72 ± 20,79 €. El coste medio fue de 10.262,62 ± 14.961,66 €, y aumentaba significativamente en relación con el ingreso hospitalario, el uso de la PCR, la realización de baciloscopia y cultivo, antibiograma, tomografía axial computarizada de tórax, biopsia pleural, tratamiento de más de 9 meses, TDO y baja laboral. En el análisis multivariante mantenían asociación independiente: ingreso hospitalario (OR = 96,8; IC: 29-472,3), antibiograma (OR = 4,34; IC: 1,71-12,1), tomografía axial computarizada de tórax (OR = 2,25; IC: 1,08-4,77), TDO (OR = 20,76; IC: 4,11-148) y baja laboral (OR = 26,9; IC: 8,51-122). Conclusión. La Tuberculosis acarrea un gasto sanitario significativo. Medidas dirigidas a mejorar el control de la enfermedad y disminuir los ingresos hospitalarios serían importantes para reducirlo


Objective. To analyze the direct and indirect costs of diagnosis and management of tuberculosis (TB) and associated factors. Patients and methods. Prospective study of patients diagnosed with TB between September 2014 and September 2015. We calculated direct (hospital stays, visits, diagnostic tests, and treatment) and indirect (sick leave and loss of productivity, contact tracing, and rehabilitation) costs. The following cost-related variables were compared: age, gender, country of origin, hospital stays, diagnostic testing, sensitivity testing, treatment, resistance, directed observed therapy (DOT), and days of sick leave. Proportions were compared using the chi-squared test and significant variables were included in a logistic regression analysis to calculate odds ratio (OR) and corresponding 95% confidence intervals. Results. 319 patients were included with a mean age of 56.72 ± 20.79 years. The average cost was €10,262.62 ± 14,961.66, which increased significantly when associated with hospital admission, polymerase chain reaction, sputum smears and cultures, sensitvity testing, chest computed tomography, pleural biopsy, drug treatment longer than nine months, DOT and sick leave. In the multivariate analysis, hospitalization (OR = 96.8; CI 29-472), sensitivity testing (OR = 4.34; CI 1.71-12.1), chest CT (OR = 2.25; CI 1.08-4.77), DOT (OR = 20.76; CI 4.11-148) and sick leave (OR = 26,9; CI 8,51-122) showed an independent association with cost. Conclusion. Tuberculosis gives rise to significant health spending. In order to reduce these costs, more control of transmission, and fewer hospital admissions would be required


Assuntos
Humanos , Masculino , Feminino , Tuberculose/economia , Tuberculose/epidemiologia , Tuberculose/prevenção & controle , Fatores de Risco , Hospitalização/economia , Custos Diretos de Serviços/tendências , Licença Médica/economia , Tempo de Internação/economia , Estudos Prospectivos , Análise Multivariada , Espanha
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