Multidrug-Resistant Pulmonary Tuberculosis
We examined the prevalence of tuberculosis (TB), rate of multidrug-resistant (MDR) TB, and characteristics of TB on a female general medicine ward in Peru. Of 250 patients, 40 (16%) were positive by sputum culture and 27 (11%) by smear, and 8 (3%) had MDRTB. Thirteen (33%) of 40 culture-positive patients had not been suspected of having TB on admission. Six (46%) of 13 patients whose TB was unsuspected on admission had MDRTB, compared with 2 (7%) of 27 suspected cases (p=0.009). Five (63%) of 8 MDRTB patients were smear positive and therefore highly infective. In developing countries, hospital control, a simple method of reducing the spread of MDRTB, is neglected.
From 1990 to 2000, tuberculosis (TB) caused an estimated 88 million new infections and 30 million deaths worldwide. In Peru, tuberculosis is highly endemic; a shantytown in Lima had an annual incidence of pulmonary tuberculosis of 364 per 100,000 population. Despite the implementation of community-based treatment and control programs in Peru, management of the disease has been complicated by high rates of multidrug-resistant (MDR) TB. In one study in Peru, 4.5% of all reported cases were resistant to isoniazid and rifampin. Nosocomial spread of MDRTB has been reported in both industrialized and developing countries and has been linked to inadequate hospital infection control practices.
We investigated the potential for nosocomial spread of MDRTB in one city hospital in Lima. We assessed the prevalence of TB among hospitalized patients on a general medicine ward, the rate of MDRTB and the extent to which active pulmonary TB had been suspected in patients at the time of admission.
We examined the prevalence of tuberculosis (TB), rate of multidrug-resistant (MDR) TB, and characteristics of TB on a female general medicine ward in Peru. Of 250 patients, 40 (16%) were positive by sputum culture and 27 (11%) by smear, and 8 (3%) had MDRTB. Thirteen (33%) of 40 culture-positive patients had not been suspected of having TB on admission. Six (46%) of 13 patients whose TB was unsuspected on admission had MDRTB, compared with 2 (7%) of 27 suspected cases (p=0.009). Five (63%) of 8 MDRTB patients were smear positive and therefore highly infective. In developing countries, hospital control, a simple method of reducing the spread of MDRTB, is neglected.
From 1990 to 2000, tuberculosis (TB) caused an estimated 88 million new infections and 30 million deaths worldwide. In Peru, tuberculosis is highly endemic; a shantytown in Lima had an annual incidence of pulmonary tuberculosis of 364 per 100,000 population. Despite the implementation of community-based treatment and control programs in Peru, management of the disease has been complicated by high rates of multidrug-resistant (MDR) TB. In one study in Peru, 4.5% of all reported cases were resistant to isoniazid and rifampin. Nosocomial spread of MDRTB has been reported in both industrialized and developing countries and has been linked to inadequate hospital infection control practices.
We investigated the potential for nosocomial spread of MDRTB in one city hospital in Lima. We assessed the prevalence of TB among hospitalized patients on a general medicine ward, the rate of MDRTB and the extent to which active pulmonary TB had been suspected in patients at the time of admission.
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