[Evaluation of the control measures adopted against an epidemic of AIDS-related multidrug-resistant tuberculosis in a Latin-American hospital].
BACKGROUND
Since 1992 AIDS-related multidrug-resistant tuberculosis (MDRTB) has been detected among patients admitted to the Hospital Muñiz in Buenos Aires (Argentina). The aim of the present study was to evaluate the effectiveness of the control measures adopted against the nosocomial spread of MDRTB/AIDS, which affected 803 patients between 1992 and 2002.


METHODS
An action plan was applied that included bacilloscopy screening on admission, isolation rooms for patients with TB/AIDS, an isolation ward for patients with MDRTB/AIDS, a radiometric method for the diagnosis of multidrug-resistance, a reserve supply of second line drugs, and respiratory protection for health care workers.


RESULTS
Between 1995 and 2002, a statistically significant decreasing trend in cases of MDRTB/AIDS and admissions for TB/AIDS was observed (33.9% vs 80.5%). Mortality among patients with MDRTB/AIDS also significantly decreased. Bacilloscopy screening allowed the diagnosis of 63.4% of patients admitted with TB/AIDS. Respiratory isolation facilities and effective treatment of patients with MDRTB diagnosed through the radiometric method were progressively implemented. Admission of patients with AIDS showed no significant variations throughout the study period. The CD41 count of patients requiring admission did not vary significantly.


CONCLUSIONS
The nosocomial epidemic curve of MDRTB in patients with AIDS significantly decreased, despite the persistence of susceptible patients with low CD41 levels. The decreasing tendency of MDRTB/AIDS cases could be attributed to the impact of the control measures implemented.
Waisman
Jaime L
JL
Sala 19, Tuberculosis multirresistente-SIDA, Buenos Aires, Argentina.
Palmero
Domingo J
DJ
Güemes-Gurtubay
José L
JL
Videla
Juan J
JJ
Moretti
Blanca
B
Cantero
Margarita
M
Ambroggi
Marta G
MG
Poggi
Susana E
SE
Sancineto
Antonio E
AE
Alberti
Federico A
FA
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology / Q000517:prevention & control*; D000995:Antitubercular Agents / Q000627:therapeutic use; D001118:Argentina / Q000453:epidemiology; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D024901:Drug Resistance, Multiple, Bacterial; D006801:Humans; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000302:isolation & purification; D010356:Patient Isolation; D014376:Tuberculosis / Q000453:epidemiology / Q000517:prevention & control*
D000995:Antitubercular Agents