Distribución geográfica y factores de riesgo de tuberculosis multidrogorresistente en el centro de Perú

espanolIntroduccion. De acuerdo con la Organizacion Mundial de la Salud, la tuberculosis multidrogorresistente (TB-MDR), definida como aquella en la que hay resistencia a isoniacida y rifampicina, representa una seria amenaza para la salud publica, ya que en 2018 se reportaron cerca de medio millon de nuevos casos de tuberculosis resistente a la rifampicina, de los cuales el 78% tenian TB-MDR. En Peru, 6 personas se enferman de tuberculosis (TB) cada hora y de los 27 000 casos notificados de enfermedad activa por ano, el 10% corresponde a TB-MDR. Objetivo. Determinar la distribucion geografica de la TB-MDR y los factores de riesgo de esta enfermedad en la region de Junin, ubicada en el centro de Peru. Materiales y metodos. Estudio longitudinal retrospectivo de casos y controles que incluyo 3 602 personas con diagnostico de tuberculosis confirmado con cultivo positivo para Mycobacterium tuberculosis entre enero y diciembre de 2016. Los casos fueron los pacientes con diagnostico de TB-MDR y los controles, los demas pacientes. Resultados. Se encontro una mayor prevalencia de casos de TB-MDR en la selva central de Peru, zona con alta incidencia de TB. Al realizar el analisis multivariado, se encontraron los siguientes factores de riesgo de multidrogorresistencia: antecedente de tratamiento de la TB (OR: 1.61, IC95%: 1.14-3.26), fracaso del tratamiento previo (OR: 5.84, IC95%: 4.03-8.21) y contacto intradomiciliario con personas con TB-MDR (OR: 91.57, IC95%: 34.56-289.14). Conclusiones. La distribucion geografica de la TB-MDR es de tipo no heterogeneo con alta incidencia en la selva central. En pacientes con diagnostico reciente de TB, se debe considerar la posibilidad de TB-MDR si presentan alguno de los factores de riesgo identificados aqui y proceden de alguna zona de alta prevalencia de esta enfermedad. EnglishIntroduction: According to the World Health Organization, multidrugresistant tuberculosis (MDR TB), defined as TB cases in which there is resistance to rifampicin and isoniazid, is a serios threat for public health, since nearly half million new cases of rinfampicin-resistant TB were reported in 2018, of which 78% were MDR TB. In Peru, 6 people fall ill with tuberculosis (TB) every hour and out of the 27 000 active TB cases reported per year, 10% are MDR TB cases. Objective: To determine the geographical distribution of MDR TB and the risk factors of this disease in the Junin region, located in central Peru. Materials and methods: Retrospective longitudinal case-control study. The study population consisted of 3 602 people with TB diagnosis confirmed with positive cultures for M. tuberculosis between January and December 2016. Cases were made up of patients diagnosed with MDR TB, and the remaining patients were the controls. Results: A higher prevalence of MDR-TB cases was observed in the central jungle of Peru, an area with a high incidence of TB. After performing the multivariate analysis, the following risks factors for developing multidrug resistance were found: history of TB treatment (OR: 1.61, 95%CI: 1.14-3.26), prior treatment failure (OR: 5.84, 95%CI: 4.03-8.21) and intra-household contact with people with MDR-TB (OR: 91.57, 95%CI: 34.56-289.14). Conclusions: The geographical distribution of MDR TB is non-heterogeneous and has a high incidence in the central jungle. In the case of patients recently diagnosed with TB, the possibility of MDR TB diagnosis should be considered if they have at least one of the risk factors identified here and come from an area where this disease is highly prevalent.