European Society of Mycobacteriology - Instituto Nacional de Saúde ...

PP-31
tuberculosis RESISTANCE in a general
hospital in portugal – 9 years surveillance
Sancho L.; Portugal C.; Tancredo L.; Silva M.; Dias A.; Silva F.; Sousa Germano
Laboratory of Microbiology, Department of Clinical Pathology
Hospital Fernando Fonseca – Amadora, Portugal
luisasancho6@gmail.com
Tuberculosis remains a serious public health problem in Portugal. In 2008, the Portuguese Health Authorities reported
a TB incidence of 25,3/100.000 inhbitants (13,6% immigrants). TB Multi Drug Resistant (MDR) were 2,5%, 34% of which
were Extensively Drug Resistant (XDR).
Resistance to any of the primary drugs makes the disease more difficult and expensive to treat.
Our Hospital is located in Lisbon’s surroundings and covers a population of 750.000 inhabitants most of them with poor
socioeconomic level and immigrants from Africa and East Countries. In the Great Lisbon are located 66% of TB cases of Portugal.
Purpose
The aim of this study was to investigate the frequency of drug resistance of Mycobacterium tuberculosis Complex in a
general Hospital in Amadora, Portugal, during a 9-year period (2000-2008).
Methods
A total of 19.417 clinical specimens (15.159 pulmonary and 4.261 extra pulmonary), collected from 9.525 patients, were
cultured for mycobateria.
Molecular genetic identification of M.tuberculosis Complex and its resistance to Isoniazid and/or Rifampicin was made
with the technology Genotype MTBDR plus (HAIN-Lifecience-Germany).
Antimycobacterial susceptibility test to the primary drugs, Streptomycin (STR), Isoniazid (INH), Rifampicin (RIF),
Ethambutol (ETB) was performed in BACTEC MGIT 960 System
Results
In 19.417 cultured clinical specimens for mycobateria, 1094 (14,2%) were positive by cultural methods.
1029 were identified as M.tuberculosis Complex; 783 (76,1%) were strains without resistance, 150 (14,6%) with one resistance,
73 (7.1%) were MDR, being more than 25% XDR.
The proportion of M.tuberculosis strains resistance rate to antituberculosis drugs during the 9-year period was: Isoniazid
11,1% (114), Streptomycin 20.2% (208)), Rifampicin 7.2% (74), and Ethambutol 4.7% (48); but in 2008 was: Isoniazid 4,8%,
Streptomicin 17%, Rifampicin 4,1% and Etambutol 2%.
On our tuberculosis population (661), in the last 6-years (2003-2008), we have compared the resistance rate related to
3 parameters: sex, age and HIV.
The tuberculosis (661) and MDR (38) populations have the same incidence rate: in male (67%) and in females (33%).
The age distribution in the MDR population (38) was 0% [0-15], 5% [16-25], 29% [26-35], 39% [36-45], 13% [46-55], 11%
[56-65], 0% [66-75], 3% [76-100]; and in patients without resistance (623) was 3% [0-15], 13% [16-25], 30% [26-35], 20%
[36-45], 14% [46-55], 8% [56-65], 7% [66-75], 5% [76-100].
The HIV parameter results were analysed on a 554 tuberculosis population. The MDR incidence rate for the HIV group
(213) was 7%, and for the no HIV group (341) was 4%.
Conclusion
The level of resistance in our population (MDR 7%) is significantly higher than Portugal’s average (2,5%)
The Multi Drug Resistance tends to be lower in the last years. The same can be observed in each of the tested drugs.
HIV infection, age and sex patient are factors that contributed to the variation of tuberculosis/MDR incidence rate.
Comparing the resistance rate by sex parameter, we didn’t found differences for tuberculosis or MDR populations; they
both have a bigger incidence in the male sex (67%).
The major incidence of tuberculosis is among active population, between 26 and 45 years old, but, it is between 36 and 45
that we found most of the MDR strains (39% of all), mostly because of drug abuse and HIV infection in this age group.
The incidence of MDR tuberculosis is clearly bigger in HIV positive (7%) than in HIV negative (4%).
Discussion
In spite of our population have a level of resistance above the Portuguese average, we noted that the number of tuberculosis
cases, including MDR, decreased 7,8% during this 9-year period analysed, which is comparable to 2008 national
data (-7.2% in the last decade).
European Society of Mycobacteriology | 30 th Annual Congress | July 2009 | Porto - Portugal
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