title: Epidemiology and clinical consequences of drug-resistant tuberculosis in a Guatemalan hospital.
abstract: OBJECTIVE
  To determine the epidemiology and clinical consequences of drug-resistant TB in Guatemala.
  
  
  METHODS
  A prospective study conducted for 12 months.
  
  
  METHODS
  A thoracic referral hospital in western Guatemala.
  
  
  METHODS
  Three hundred and seventy-six patients with confirmed TB.
  
  
  RESULTS
  Of 376 confirmed cases, 335 (89%) were culture-positive. Tests of drug sensitivities to four first-line antituberculous drugs were performed in 172 (51%) of the culture-positive cases. Fifty-one patients (30%) were resistant to at least one antimicrobial agent, and 26 (15%) were resistant to at least two drugs. In a multivariate model of clinically available patient characteristics, only cavitary disease (odds ratio=2.1; 95% confidence interval, 1.1-6.6) and a history of taking anti-TB medication for >2 weeks (OR=3.0; 95% CI, 1.5-10.3) were independent predictors of resistance to two or more anti-TB agents. Resistance to two or more anti-TB drugs was the single independent predictor of treatment failure (OR=6.4; 95% CI, 2.3-17.8). Twenty-four of 172 patients (14%) who denied having received prior anti-TB therapy were infected with resistant organisms, suggesting ongoing transmission of drug-resistant strains. Although 84% (69 of 82 cases) of patients with fully susceptible organisms and 89% (17 of 19 cases) with singly resistant organisms were cured, only 45% of patients (10 of 22 cases) infected with organisms resistant to two or more agents were successfully treated.
  
  
  CONCLUSIONS
  At this sentinel site for complicated TB, a substantial subset of cases who are infected with drug-resistant bacteria cannot be easily identified or treated.
authors.affiliation: Department of Medicine, Eastern Maine Medical Center, Bangor 04401, USA.
authors.forename: E M
authors.initials: EM
authors.lastname: Harrow
authors.forename: J M
authors.initials: JM
authors.lastname: Rangel
authors.forename: J M
authors.initials: JM
authors.lastname: Arriega
authors.forename: I
authors.initials: I
authors.lastname: Cohen
authors.forename: M I
authors.initials: MI
authors.lastname: Régil Ruíz
authors.forename: K
authors.initials: K
authors.lastname: DeRiemer
authors.forename: P M
authors.initials: PM
authors.lastname: Small
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000627:therapeutic use; D002648:Child; D005260:Female; D006166:Guatemala / Q000453:epidemiology; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000453:epidemiology / Q000635:transmission
chemical_list: D000995:Antitubercular Agents