RESUMEN
INTRODUCTION: The epidemiological characteristics of patients with tuberculosis (TB) in European hospitals have changed in recent years. METHODS: A prospective study of patients with culture-proven pulmonary TB admitted to our institution from 1997 to 2008 is shown. RESULTS: We analyzed 661 patients with pulmonary TB. An increase in the incidence of TB was confirmed during the study period (P<.001). The proportion of patients with HIV infection decreased from 26% during 1997-2000 to 12% during 2005-2008. However, the proportions of older (>40 years old) and foreign-born patients increased significantly, from 37% to 59% and from 12% to 35%, respectively. Multivariate analysis confirmed previous antituberculous therapy and immigration as factors associated with resistance to isoniazid and to isoniazid+rifampin. After the year 2000, mortality was independently associated with extrapulmonary TB (OR: 3.1; CI 95%: 1.4-7.2), hepatitis C virus infection (OR: 6.0; CI 95%: 2.2-16.3), and diabetes (OR: 6.4; CI 95%: 2.4-16.8). CONCLUSION: Immigration from countries with high rates of TB infection has replaced HIV infection as the most relevant risk factor associated with TB. The increase in the number of older patients with TB and the presence of specific comorbid conditions, especially chronic liver dysfunction, could explain the more difficult management and increased mortality.
Asunto(s)
Emigración e Inmigración/estadística & datos numéricos , Tuberculosis/epidemiología , Adulto , África/etnología , Distribución por Edad , Anciano , Anciano de 80 o más Años , Antituberculosos/farmacología , Antituberculosos/uso terapéutico , Comorbilidad , Diabetes Mellitus/epidemiología , Farmacorresistencia Bacteriana Múltiple , Europa (Continente)/etnología , Infecciones por VIH/epidemiología , Hepatitis Viral Humana/epidemiología , Hospitales Universitarios/estadística & datos numéricos , Hospitales Urbanos/estadística & datos numéricos , Humanos , Isoniazida/farmacología , América Latina/etnología , Persona de Mediana Edad , Estudios Prospectivos , España/epidemiología , Tuberculosis/tratamiento farmacológico , Tuberculosis Resistente a Múltiples Medicamentos/epidemiología , Tuberculosis Pulmonar/epidemiología , Adulto JovenRESUMEN
Introduction: The epidemiological characteristics of patients with tuberculosis (TB) in European hospital shave changed in recent years. Methods: A prospective study of patients with culture-proven pulmonary TB admitted to our institution from 1997 to 2008 is shown. Results: We analyzed 661 patients with pulmonary TB. An increase in the incidence of TB was confirmed during the study period (P<.001). The proportion of patients with HIV infection decreased from 26% during1997-2000 to 12% during 2005-2008. However, the proportions of older (>40 years old) and foreign-bornpatients increased significantly, from 37% to 59% and from 12% to 35%, respectively. Multivariate analysis confirmed previous antituberculous therapy and immigration as factors associated with resistance toisoniazid and to isoniazid+rifampin. After the year 2000, mortality was independently associated with extrapulmonary TB (OR: 3.1; CI 95%: 1.4-7.2), hepatitis C virus infection (OR: 6.0; CI 95%: 2.2-16.3), and diabetes (OR: 6.4; CI 95%: 2.4-16.8).Conclusion: Immigration from countries with high rates of TB infection has replaced HIV infection as the most relevant risk factor associated with TB. The increase in the number of older patients with TB and the presence of specific comorbid conditions, especially chronic liver dysfunction, could explain the more difficult management and increased mortality (AU)
Introducción: La epidemiología de los pacientes con tuberculosis ha cambiado en los hospitales europeos en los últimos años. Métodos: Presentamos un estudio prospectivo en pacientes hospitalizados en nuestra institución con tuberculosis confirmada por cultivo entre los años 1997 y 2008.Resultados: Se analizaron 661 pacientes con tuberculosis pulmonar. Durante el período de estudio se confirmó un incremento de la incidencia (p < 0,001). El porcentaje de pacientes con infección por VIH disminuyó desde el 26% en los años 1997-2000 al 12% en los años 2005-2008. Sin embargo, la proporción de pacientes mayores de 40 años e inmigrantes se incrementó de forma significativa, desde el 37 al 59% y desde el 12 al 35% respectivamente. El análisis multivariante confirmó el tratamiento antituberculoso previo y la inmigración como factores asociados a resistencia a isoniazida y a isoniazida-rifampicina. Después del año 2000 la mortalidad se asoció de forma independiente con la presencia de tuberculosis extrapulmonar (OR: 3,1; IC 95%: 1,4-7,2), infección por virus de la hepatitis C (OR: 6,0; IC 95%: 2,2-16,3),y diabetes (OR: 6,4; IC 95%: 2,4-16,8) (AU)