title: Diabetes and Other Risk Factors for Multi-drug Resistant Tuberculosis in a Mexican Population with Pulmonary Tuberculosis: Case Control Study.
abstract: OBJECTIVE
  Multidrug resistant tuberculosis (MDR-TB) poses problems in treatment, costs and treatment outcomes. It is not known if classically described risk factors for MDR-TB in other countries are the same in Mexico and the frequency of the association between diabetes mellitus (DM) and MDR-TB in our country is not clear. We undertook this study to analyze risk factors associated with the development of MDR-TB, with emphasis on DM.
  
  
  METHODS
  A case-control study in the state of San Luis Potosi (SLP), Mexico was carried out. All pulmonary MDR-TB patients diagnosed in the state of SLP between 1998 and 2013 (36 cases) evaluated at a state pharmacoresistant tuberculosis (TB) clinic and committee; 139 controls were randomly selected from all pulmonary non-multidrug-resistant tuberculosis (non-MDR-TB) cases identified between 2003 and 2008. Cases and controls were diagnosed and treated under programmatic conditions.
  
  
  RESULTS
  Age, gender, malnutrition, being a health-care worker, HIV/AIDS status, and drug abuse were not significantly different between MDR-TB and non-MDR-TB patients. Significant differences between MDR-TB and non-MDR-TB patients were DM (47.2 vs. 28.1%; p = 0.028); previous anti-TB treatments (3 vs. 0, respectively; p <0.001), and duration of first anti-TB treatment (8 vs. 6 months, respectively; p <0.001).
  
  
  CONCLUSIONS
  MDR-TB and DM are associated in 47.2% of MDR TB cases (17/36) in this study. Other recognized factors were not found to be significantly different in MDR-TB compared to non-MDR-TB in this study. Cost-feasible strategies must be implemented in the treatment of DM-TB in order to prevent the selection of MDR-TB.
authors.affiliation: División de Medicina Interna, Hospital Central "Dr. Ignacio Morones Prieto", San Luis Potosí, México; Departamento de Medicina Interna, Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México; Comité Estatal de Tuberculosis Farmacorresistente, San Luis Potosí, México. Electronic address: agomez.cer@prodigy.net.mx.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Gómez-Gómez
authors.affiliation: División de Medicina Interna, Hospital Central "Dr. Ignacio Morones Prieto", San Luis Potosí, México; Departamento de Medicina Interna, Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México; Comité Estatal de Tuberculosis Farmacorresistente, San Luis Potosí, México.
authors.forename: Martin
authors.initials: M
authors.lastname: Magaña-Aquino
authors.affiliation: Programa de Atención al Adulto Mayor, San Luis Potosí, México.
authors.forename: Salvador
authors.initials: S
authors.lastname: López-Meza
authors.affiliation: Dirección de Políticas y Calidad en Salud, San Luis Potosí, México.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Aranda-Álvarez
authors.affiliation: Programa de Micobacteriosis Servicios de Salud del Estado de San Luis Potosí, San Luis Potosí, México.
authors.forename: Dora E
authors.initials: DE
authors.lastname: Díaz-Ornelas
authors.affiliation: Servicio de Medicina Preventiva, Hospital Central "Dr. Ignacio Morones Prieto", San Luis Potosí, México.
authors.forename: María Guadalupe
authors.initials: MG
authors.lastname: Hernández-Segura
authors.affiliation: Asesor Nacional en Tuberculosis Farmacorresistente, Instituto Nacional de Enfermedades Respiratorias, México, D.F., México.
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: Salazar-Lezama
authors.affiliation: Dirección Programa Nacional de Tuberculosis, Secretaría de Salud, México, D.F., México.
authors.forename: Martín
authors.initials: M
authors.lastname: Castellanos-Joya
authors.affiliation: Departmento de Microbiología, Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Noyola
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D000904:Antibiotics, Antitubercular / Q000627:therapeutic use; D015373:Bacterial Typing Techniques; D016022:Case-Control Studies; D048909:Diabetes Complications / Q000382:microbiology*; D003920:Diabetes Mellitus / Q000473:pathology*; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics*; D005260:Female; D017048:Health Care Costs; D006282:Health Personnel; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use; D008297:Male; D008800:Mexico; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000235:genetics; D012293:Rifampin / Q000627:therapeutic use; D012307:Risk Factors; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality
chemical_list: D000904:Antibiotics, Antitubercular; D007538:Isoniazid; D012293:Rifampin
keywords: Diabetes; Latin America; MDR-TB