Clinical and programmatic mismanagement rather than community outbreak as the cause of chronic, drug-resistant tuberculosis in Buenaventura, Colombia, 1998.
METHODS
Buenaventura, Colombia.


OBJECTIVE
To assess whether antituberculosis drug resistance was generated by poor management or community transmission.


METHODS
Treatment-failure and new tuberculosis (TB) patients identified between May 1997 and June 1998 were interviewed and their treatment histories reviewed. Bacteriologic testing, including drug susceptibility profiles (DSP) and DNA fingerprinting by restriction fragment length polymorphism (RFLP), was performed and human immunodeficiency virus (HIV) testing was offered.


RESULTS
DSP and RFLP fingerprints were obtained for isolates from 34 of 64 treatment-failure patients; 25 (74%) were resistant to > or = one drug. Fifteen of the 25 patients consented to HIV testing; none were positive. An average of 2.8 major treatment errors per patient was identified. RFLP from the treatment-failure patients revealed 20 unique isolates and six clusters (isolates with identical RFLP); 4/6 clusters contained isolates with different DSP. Analysis of the RFLP from both treatment-failure and new patients revealed that 44/111 (40%) isolates formed 18 clusters. Four of 47 (9%) new patients had multidrug-resistant TB (MDR-TB). Eleven isolates belonged to the Beijing family, related to the MDR strain W.


CONCLUSIONS
Drug resistance in Buenaventura results from both poor management and community transmission. Dependence on DSP to identify TB transmission is inadequate when programmatic mismanagement is common.
Laserson
K F
KF
Division of TB Elimination, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta 30333, GA, USA.
Osorio
L
L
Sheppard
J D
JD
Hernández
H
H
Benitez
A M
AM
Brim
S
S
Woodley
C L
CL
Hazbón
M H
MH
Villegas
M V
MV
Castaño
M C
MC
Henriquez
N
N
Rodriguez
E
E
Metchock
B
B
Binkin
N J
NJ
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology; D003105:Colombia / Q000453:epidemiology; D016172:DNA Fingerprinting; D004196:Disease Outbreaks; D006801:Humans; D019300:Medical Errors; D012150:Polymorphism, Restriction Fragment Length; D015397:Program Evaluation; D017211:Treatment Failure; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology* / Q000235:genetics