title: Social and clinical predictors of drug-resistant tuberculosis in a public hospital, Monterrey, Mexico.
abstract: OBJECTIVE
  Drug-resistant tuberculosis (DRTB) is steadily increasing in Mexico, but little is known of patient risk factors in the Mexico-United States border region. This preliminary case-control study included 95 patients with active pulmonary TB with drug susceptibility results attending the José E. González University Hospital in the urban hub of Nuevo León-the Monterrey Metropolitan Area. We report potential social and clinical risk factors of DRTB among this hospital-based sample.
  
  
  METHODS
  We collected data through face-to-face interviews and medical record reviews from 25 cases with DRTB and 70 drug-sensitive controls. DNA was collected to assess an effect of genetic ancestry on DRTB by using a panel of 291,917 genomic markers. We calculated crude and multivariate logistic regression.
  
  
  RESULTS
  After adjusting for potential confounding factors, we found that prior TB treatment (odds ratio, 4.5; 95% confidence interval, 0.9-21.1) and use of crack cocaine (odds ratio, 4.6; 95% confidence interval, 1.1-18.7) were associated with DRTB. No other variables, including genetic ancestry and comorbidities, were predictive.
  
  
  CONCLUSIONS
  Health care providers may benefit from recognizing predictors of DRTB in regions where routine drug susceptibility testing is limited. Prior TB treatment and illicit drug use, specifically crack cocaine, may be important risk factors for DRTB in this region.
authors.affiliation: Department of Anthropology, University of New Mexico, Albuquerque. Electronic address: byoung@unm.edu.
authors.forename: Bonnie N
authors.initials: BN
authors.lastname: Young
authors.affiliation: Department of Internal Medicine, University of New Mexico, Albuquerque.
authors.forename: Marcos
authors.initials: M
authors.lastname: Burgos
authors.affiliation: Department of Family and Community Medicine, University of New Mexico, Albuquerque.
authors.forename: Alexis J
authors.initials: AJ
authors.lastname: Handal
authors.affiliation: Geospatial and Population Studies, Institute for Applied Research Services, University of New Mexico, Albuquerque.
authors.forename: Jack
authors.initials: J
authors.lastname: Baker
authors.affiliation: Tuberculosis Clinic, Pulmonary Services and Clinical Pathology Laboratory, Hospital Universitario José E. González, Universidad Autónoma de Nuevo León, Monterrey, Mexico.
authors.forename: Adrian
authors.initials: A
authors.lastname: Rendón
authors.affiliation: Department of Immunology, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico.
authors.forename: Adrian
authors.initials: A
authors.lastname: Rosas-Taraco
authors.affiliation: Department of Anthropology, University of New Mexico, Albuquerque.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Long
authors.affiliation: Department of Anthropology, University of New Mexico, Albuquerque.
authors.forename: Keith
authors.initials: K
authors.lastname: Hunley
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D019970:Cocaine-Related Disorders / Q000453:epidemiology*; D015897:Comorbidity; D016578:Crack Cocaine / Q000009:adverse effects*; D004247:DNA / Q000032:analysis / Q000235:genetics; D005260:Female; D005819:Genetic Markers; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D009161:Mycobacterium / Q000235:genetics*; D012008:Recurrence; D012307:Risk Factors; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology / Q000235:genetics* / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000453:epidemiology / Q000235:genetics
chemical_list: D016578:Crack Cocaine; D005819:Genetic Markers; D004247:DNA
keywords: Case-control studies; Drug resistance; Mexico; Tuberculosis; Urban hospitals