[Drug resistance profile of Mycobacterium tuberculosis in the state of Mato Grosso do Sul, Brazil, 2000-2006].
OBJECTIVE
To determine the drug resistance profile of Mycobacterium tuberculosis in the state of Mato Grosso do Sul, Brazil, between 2000 and 2006.


METHODS
Descriptive study of reported tuberculosis cases in the Brazilian Case Registry Database. We included only those cases in which M. tuberculosis culture was positive and sensitivity to drugs (rifampicin, isoniazid, streptomycin and ethambutol) was tested. Löwenstein-Jensen and Ogawa-Kudoh solid media were used for cultures, as was an automated liquid medium system. Sensitivity tests were based on the proportion method.


RESULTS
Among the 783 cases evaluated, males predominated (69.7%), as did patients in the 20-49 year age bracket (70%), a diagnosis of pulmonary tuberculosis (94.4%) and positive HIV serology (8.6%); 645 (82.4%) were new cases, and 138 (17.6%) had previously been treated. Resistance to at least one drug was found in 143 cases (18.3%). The primary resistance (PR) rate was, respectively, 8.1%, 1.6%, 2.8% and 12.4%, for monoresistance, multidrug resistance (MDR), other patterns of resistance and resistance to at least one drug, whereas the acquired resistance (AR) rate was 14.5%, 20.3%, 10.9% and 45.7%, respectively, and the combined resistance (CR) rate was 9.2%, 4.9%, 4.2% and 18.3%, respectively. In PR, streptomycin was the most common drug, whereas isoniazid was the most common in AR and CR (7.2% and 3.7%, respectively).


CONCLUSIONS
These high levels of resistance undermine the efforts for tuberculosis control in Mato Grosso do Sul. Acquired MDR was 12.7 times more common than was primary MDR, demonstrating that the previous use of drug therapy is an indicator of resistance. These levels reflect the poor quality of the health care provided to these patients, showing the importance of using the directly observed treatment, short course strategy, as well as the need to perform cultures and sensitivity tests for the early diagnosis of drug resistance.
Marques
Marli
M
Programa Estadual de Controle da Tuberculose, Secretaria de Estado da Saúde de Mato Grosso do Sul, Campo Grande, MS, Brasil. marli.marques2008@gmail.com
Cunha
Eunice Atsuko Totumi
EA
Ruffino-Netto
Antonio
A
Andrade
Sonia Maria de Oliveira
SM
D000328:Adult; D000995:Antitubercular Agents / Q000145:classification / Q000627:therapeutic use*; D001938:Brazil / Q000453:epidemiology; D024881:Drug Resistance, Bacterial / Q000502:physiology*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000382:microbiology*; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects*; D013307:Streptomycin / Q000627:therapeutic use; D013997:Time Factors; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D055815:Young Adult
D000995:Antitubercular Agents; D007538:Isoniazid; D013307:Streptomycin