A population-based study of drug resistance and transmission of tuberculosis in an urban community.
METHODS
A low-income neighborhood of Sao Paulo, Brazil.


OBJECTIVE
To determine the incidence, risk factors and transmission patterns of multidrug-resistant tuberculosis (MDR-TB).


METHODS
Prospective longitudinal study of patients with pulmonary TB (PTB).


METHODS
Sputum culture-confirmed patients with PTB were recruited between March 2000 and May 2002. Bivariate and multivariate logistic regression analyses were performed to identify factors associated with MDR-TB. Mycobacterium tuberculosis isolates were tested for drug susceptibility and typed by IS6110-RFLP analysis.


RESULTS
Of 420 patients, respectively 71% and 27% were new and previously treated; 15.5% of the patients' M. tuberculosis isolates were resistant to at least one drug; of these, 11% and 27% were found among new and previously treated cases, respectively. Respectively 1% and 16.7% of the new and previously treated cases were MDR-TB. RFLP analysis showed that new transmission of MDR strains was uncommon. By multivariate logistic regression analysis, previous TB and hospitalization in the 24 months before TB diagnosis were identified as independent predictors of MDR-TB.


CONCLUSIONS
The results showed an intermediate level of MDR-TB incidence in a neighborhood of Sao Paulo and identified predictors that can be targeted for intervention by national and local TB control programs.
Telles
M A S
MA
Setor de Micobactérias, Instituto Adolfo Lutz, São Paulo, Brazil. atelles@osite.com.br
Ferrazoli
L
L
Waldman
E A
EA
Giampaglia
C M S
CM
Martins
M C
MC
Ueki
S Y M
SY
Chimara
E
E
Silva
C A
CA
Cruz
V
V
Waldman
C C S
CC
Heyn
I
I
Hirono
I U
IU
Riley
L W
LW
D000293:Adolescent; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012150:Polymorphism, Restriction Fragment Length; D011203:Poverty; D011446:Prospective Studies; D012307:Risk Factors; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology* / Q000635:transmission*; D014505:Urban Population