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Volume 328:521-526 February 25, 1993 Number 8 Next

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ABSTRACT

Background In the past decade the incidence of tuberculosis has increased nationwide and more than doubled in New York City, where there have been recent nosocomial outbreaks of multidrug-resistant tuberculosis.

Methods We collected information on every patient in New York City with a positive culture for Mycobacterium tuberculosis during April 1991. Drug-susceptibility testing was performed at the Centers for Disease Control and Prevention.

Results Of the 518 patients with positive cultures, 466 (90 percent) had isolates available for testing. Overall, 33 percent of these patients had isolates resistant to one or more antituberculosis drugs, 26 percent had isolates resistant to at least isoniazid, and 19 percent had isolates resistant to both isoniazid and rifampin. Of the 239 patients who had received antituberculosis therapy, 44 percent had isolates resistant to one or more drugs and 30 percent had isolates resistant to both isoniazid and rifampin. Among the patients who had never been treated, the proportion with resistance to one or more drugs increased from 10 percent in 1982 through 1984 to 23 percent in 1991 (P = 0.003). Patients who had never been treated and who were infected with the human immunodeficiency virus (HIV) or reported injection-drug use were more likely to have resistant isolates. Among patients with the acquired immunodeficiency syndrome, those with resistant isolates were more likely to die during follow-up through January 1992 (80 percent vs. 47 percent, P = 0.02). A history of antituberculosis therapy was the strongest predictor of the presence of resistant organisms (odds ratio, 2.7; P<0.001).

Conclusions There has been a marked increase in drug-resistant tuberculosis in New York City. Previously treated patients, those infected with HIV, and injection-drug users are at increased risk for drug resistance. Measures to control and prevent drug-resistant tuberculosis are urgently needed.

Source Information

From the Division of Field Epidemiology, Epidemiology Program Office (T.R.F.), the Division of Mycotic and Bacterial Diseases, National Center for Infectious Diseases (J.O.K.), and the Division of Tuberculosis Elimination, National Center for Prevention Services (G.M.C., S.W.D.), Centers for Disease Control and Prevention, Atlanta; the Division of Disease Intervention, New York City Department of Health, New York (T.R.F.); and Columbia-Presbyterian Medical Center, New York (T.S., A.P.-M.).

Address reprint requests to Dr. Frieden at 125 Worth St., Box 74, New York, NY 10013.

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Related Letters:

Drug-Resistant Tuberculosis in New York City
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