RESUMEN
BACKGROUND: Since 1992 AIDS-related multidrug-resistant tuberculosis (MDRTB) has been detected among patients admitted to the Hospital Muñiz in Buenos Aires (Argentina). The aim of the present study was to evaluate the effectiveness of the control measures adopted against the nosocomial spread of MDRTB/AIDS, which affected 803 patients between 1992 and 2002. METHODS: An action plan was applied that included bacilloscopy screening on admission, isolation rooms for patients with TB/AIDS, an isolation ward for patients with MDRTB/AIDS, a radiometric method for the diagnosis of multidrug-resistance, a reserve supply of second line drugs, and respiratory protection for health care workers. RESULTS: Between 1995 and 2002, a statistically significant decreasing trend in cases of MDRTB/AIDS and admissions for TB/AIDS was observed (33.9% vs 80.5%). Mortality among patients with MDRTB/AIDS also significantly decreased. Bacilloscopy screening allowed the diagnosis of 63.4% of patients admitted with TB/AIDS. Respiratory isolation facilities and effective treatment of patients with MDRTB diagnosed through the radiometric method were progressively implemented. Admission of patients with AIDS showed no significant variations throughout the study period. The CD41 count of patients requiring admission did not vary significantly. CONCLUSION: The nosocomial epidemic curve of MDRTB in patients with AIDS significantly decreased, despite the persistence of susceptible patients with low CD41 levels. The decreasing tendency of MDRTB/AIDS cases could be attributed to the impact of the control measures implemented.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/prevención & control , Infección Hospitalaria/prevención & control , Tuberculosis/prevención & control , Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Antituberculosos/uso terapéutico , Argentina/epidemiología , Infección Hospitalaria/epidemiología , Farmacorresistencia Bacteriana Múltiple , Humanos , Mycobacterium tuberculosis/efectos de los fármacos , Mycobacterium tuberculosis/aislamiento & purificación , Aislamiento de Pacientes , Tuberculosis/epidemiologíaRESUMEN
Desde 1992 se detectaron pacientes con tuberculosis multirresistente (TBMR) asociada al sida internados en el Hospital Muñiz (Buenos Aires). El objetivo del trabajo es evaluar la eficacia de las medidas adoptadas frente a la expansión nosocomial de la TBMR/sida, que afectó a 803 enfermos entre 1992-2002. Métodos. Se aplicó un plan de acción que incluyó: cribado baciloscópico de admisión, habitaciones de aislamiento para TB/sida, sala de aislamiento para TBMR/sida, diagnóstico de multirresistencia mediante método radiométrico; banco de fármacos de segunda línea y protección respiratoria del personal de salud. Resultados. Entre 1995 y 2002, se observó una tendencia estadísticamente significativa en la disminución de casos de TBMR/sida y de los internamientos por TB/sida (33,9% frente a 80,5%, respectivamente), así como una disminución significativa en la mortalidad de los primeros. El cribado baciloscópico permitió diagnosticar el 63,4% de los casos de TB/sida internados. Progresivamente fueron empleados los recursos de aislamiento respiratorio y tratamiento eficaz de los casos de TBMR diagnosticados por método radiométrico. Respecto de la población susceptible, el ingreso de pacientes con sida al hospital no varió significativamente a lo largo del período estudiado, tampoco lo hizo el recuento de linfocitos T CD41 de los pacientes que requirieron internamiento. Conclusión. Se observó una disminución significativa de la curva epidémica nosocomial de TBMR en pacientes con sida, pese a la persistencia de pacientes susceptibles con bajo nivel de linfocitos T CD41. Se considera que esta evolución decreciente de la TBMR/sida puede ser atribuida al impacto de las medidas de control implementadas (AU)
Since 1992 AIDS-related multidrug-resistant tuberculosis (MDRTB) has been detected among patients admitted to the Hospital Muñiz in Buenos Aires (Argentina). The aim of the present study was to evaluate the effectiveness of the control measures adopted against the nosocomial spread of MDRTB/AIDS, which affected 803 patients between 1992 and 2002. Methods. An action plan was applied that included bacilloscopy screening on admission, isolation rooms for patients with TB/AIDS, an isolation ward for patients with MDRTB/AIDS, a radiometric method for the diagnosis of multidrug-resistance, a reserve supply of second line drugs, and respiratory protection for health care workers. Results. Between 1995 and 2002, a statistically significant decreasing trend in cases of MDRTB/AIDS and admissions for TB/AIDS was observed (33.9% vs 80.5%). Mortality among patients with MDRTB/AIDS also significantly decreased. Bacilloscopy screening allowed the diagnosis of 63.4% of patients admitted with TB/AIDS. Respiratory isolation facilities and effective treatment of patients with MDRTB diagnosed through the radiometric method were progressively implemented. Admission of patients with AIDS showed no significant variations throughout the study period. The CD41 count of patients requiring admission did not vary significantly. Conclusion. The nosocomial epidemic curve of MDRTB in patients with AIDS significantly decreased, despite the persistence of susceptible patients with low CD41 levels. The decreasing tendency of MDRTB/AIDS cases could be attributed to the impact of the control measures implemented (AU)