title: Drug-resistant tuberculosis in six hospitals in Rio de Janeiro, Brazil.
abstract: METHODS
  Tuberculosis (TB) drug resistance survey in six hospitals in Rio de Janeiro, Brazil.
  
  
  OBJECTIVE
  To estimate resistance to at least one drug (DR) and multidrug resistance (MDR) and identify associated factors.
  
  
  METHODS
  One-year cross-sectional survey. Hospitals were included as a convenience sample.
  
  
  RESULTS
  Of 595 patients investigated, 156 (26.2%) had previously undergone anti-tuberculosis treatment, 433 (72.8%) were not previously treated and information on the remaining 6 was not available. Overall, DR and MDR rates were high, at respectively 102 (17.1%, 95%CI 14.3-20.5) and 44 (7.4%, 95%CI 5.5-9.9) cases. Among individuals not previously treated, 17 had MDR (3.9%, 95%CI 2.4-6.3) and diagnosis in a TB reference hospital was independently associated with MDR (prevalence ratio [PR] 3.3, 95%CI 1.2-8.7) after multivariate analysis. Among previously treated individuals, 27 had MDR (17.3%, 95%CI 11.7-24.2). MDR-TB was independently associated with diagnosis in a TB reference hospital (PR 3.6, 95%CI 1.5-8.7), male sex (PR 2.3, 95%CI 1.2-4.4) and dyspnoea (PR 0.3, 95%CI 0.1-0.7).
  
  
  CONCLUSIONS
  We found high levels of DR- and MDR-TB. Our study design did not permit us to determine the contribution of community versus nosocomial transmission. Further studies are needed to establish this. Nevertheless, hospitals should be recognised as a potential source of transmission of resistant TB strains and urgent measures to avoid nosocomial TB transmission should be taken.
authors.affiliation: Programa de Controle da Tuberculose, Secretaria de Estado de Saúde e Defesa Civil do Rio de Janeiro, Rua México 128, Sala 411, Centro, Rio de Janeiro 20031 142, RJ, Brazil. rossanacb@terra.com.br
authors.forename: R C
authors.initials: RC
authors.lastname: Brito
authors.forename: F C Q
authors.initials: FC
authors.lastname: Mello
authors.forename: M K
authors.initials: MK
authors.lastname: Andrade
authors.forename: H
authors.initials: H
authors.lastname: Oliveira
authors.forename: W
authors.initials: W
authors.lastname: Costa
authors.forename: H J
authors.initials: HJ
authors.lastname: Matos
authors.forename: M C
authors.initials: MC
authors.lastname: Lourenço
authors.forename: V C
authors.initials: VC
authors.lastname: Rolla
authors.forename: L
authors.initials: L
authors.lastname: Fonseca
authors.forename: A
authors.initials: A
authors.lastname: Ruffino Netto
authors.forename: A L
authors.initials: AL
authors.lastname: Kritski
mesh_terms: D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000494:pharmacology*; D001938:Brazil / Q000453:epidemiology; D003140:Communicable Disease Control / Q000379:methods; D003428:Cross Infection / Q000517:prevention & control; D003430:Cross-Sectional Studies; D024881:Drug Resistance, Bacterial; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009169:Mycobacterium tuberculosis; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors; D014376:Tuberculosis / Q000188:drug therapy / Q000453:epidemiology* / Q000635:transmission; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000453:epidemiology* / Q000635:transmission
chemical_list: D000995:Antitubercular Agents