Multidrug-resistant pulmonary tuberculosis in Esmeraldas, Ecuador (2018–2022): prevalence and clinical–epidemiological profile from a retrospective observational study

Jaime Angamarca-Iguago

doi:10.16921/pfr.v10i2.364

Jaime Angamarca-Iguago Centro de Investigación de Salud Pública y Epidemiología Clínica (CISPEC), Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE. Quito, Ecuador.

DOI: https://doi.org/10.16921/pfr.v10i2.364

Resumen

Background: Multidrug-resistant tuberculosis (MDR-TB) remains a growing public health concern globally, particularly in settings with limited diagnostic capacity and high disease burden. In Ecuador, Esmeraldas province has reported a disproportionately high number of TB cases. However, local evidence on resistance patterns and patient characteristics is scarce.

Objective: To estimate the prevalence of MDR-TB and describe its epidemiological and clinical characteristics in the province of Esmeraldas, Ecuador, from 2018 to 2022.

Methods: A descriptive, cross-sectional study was conducted using secondary data from Ecuador's Ministry of Public Health. Confirmed pulmonary TB cases with positive culture or GeneXpert results were analyzed. MDR-TB prevalence rates were calculated, and patient characteristics were stratified by sex, age, district of residence, TB contact history, and drug resistance profile. Statistical analysis included univariate and bivariate procedures, with prevalence odds ratios (OR) and chi-square tests.

Results: Among 1,461 confirmed TB cases reported in Zone 1, 902 (61.7%) were from Esmeraldas. Of these, 49 (5.4%) were identified as MDR-TB. The mean annual MDR-TB prevalence in Esmeraldas was 1.7 cases per 100,000 population. The majority of MDR-TB patients were male (59.2%), aged 20–49 years (82%), and urban residents (79.6%). Rifampicin resistance was found in 91.8% of cases. Relapse cases showed a significantly higher odds of resistance (OR = 3.48). One case met the criteria for extensively drug-resistant TB (XDR-TB). Treatment outcomes were incomplete in 41% of cases; among reported outcomes, cure rate was 22.4%, and the case fatality rate was 10.2%.

Conclusions: MDR-TB remains a persistent threat in Esmeraldas, with relapse and urban residence as prominent risk markers. The detection of XDR-TB and treatment discontinuation rates highlight critical weaknesses in the TB control program. Targeted strategies to improve rapid diagnostics, follow-up, and data quality are urgently needed to contain the spread of resistance and achieve TB elimination goals in Ecuador.

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