Nationwide survey of drug-resistant tuberculosis in the United States.

OBJECTIVE To determine antituberculosis drug resistance patterns, geographic distribution, demographic characteristics, and risk factors of reported tuberculosis (TB) patients in the United States. DESIGN Survey of reported TB cases in the United States. For culture-positive cases reported to the Centers for Disease Control and Prevention, we asked health departments to provide drug susceptibility test results from initial Mycobacterium tuberculosis isolates. STUDY POPULATION Culture-positive TB cases in the United States reported during the first quarter of 1991. MAIN OUTCOME MEASURES Individual TB case reports submitted to the Centers for Disease Control and Prevention and drug susceptibility test results. RESULTS Resistance to one or more antituberculosis drugs was found in 14.2% of cases. Resistance to isoniazid and/or rifampin was found in 9.5% of cases whose isolates were tested against one or both drugs; such cases were found in 107 counties in 33 states. Resistance to both isoniazid and rifampin (multidrug-resistant [MDR] TB) was found in 3.5% of cases whose isolates were tested against both drugs; such cases were found in 35 counties in 13 states. New York City accounted for 61.4% of the nation's MDR TB cases. The 3-month population-based incidence rate of MDR TB in New York City was 52.4 times (95% confidence interval [CI], 35.5 to 78.3) that of the rest of the nation (9.559 vs 0.182 cases per million population). Compared with the rate in non-Hispanic whites in the rest of the nation (0.032 cases per million), the relative risk of MDR TB in New York City non-Hispanic whites was 39.0 (95% CI, 8.1 to 164.5), 299.3 (95% CI, 112.5 to 927.1) in Hispanics, 420.9 (95% CI, 121.0 to 1515.8) in Asian/Pacific Islanders, and 701.0 (95% CI, 296.4 to 2018.1) in non-Hispanic blacks. CONCLUSIONS With nearly 10% of TB patients resistant to isoniazid and/or rifampin, greater use of four-drug regimens and directly observed therapy is indicated. Aggressive intervention to prevent the further spread of MDR TB is needed to find every TB patient and to provide optimal patient management to ensure completion of chemotherapy.

[1]  S. Ostroff,et al.  Transmission of Multidrug-Resistant Mycobacterium tuberculosis Among Persons Exposed in a Medical Examiner's Office, New York , 1995, Infection Control & Hospital Epidemiology.

[2]  C. Woodley,et al.  Multidrug-resistant tuberculosis in the New York State prison system, 1990-1991. , 1994, The Journal of infectious diseases.

[3]  D. Snider,et al.  Treatment of tuberculosis and tuberculosis infection in adults and children. American Thoracic Society and The Centers for Disease Control and Prevention. , 1994, American journal of respiratory and critical care medicine.

[4]  A K Highsmith,et al.  Surveillance for waterborne disease outbreaks--United States, 1991-1992. , 1993, MMWR. CDC surveillance summaries : Morbidity and mortality weekly report. CDC surveillance summaries.

[5]  J. Kent,et al.  The epidemiology of multidrug-resistant tuberculosis in the United States. , 1993, The Medical clinics of North America.

[6]  J. T. Crawford,et al.  Transmission of multidrug-resistant Mycobacterium tuberculosis among persons with human immunodeficiency virus infection in an urban hospital: epidemiologic and restriction fragment length polymorphism analysis. , 1993, The Journal of infectious diseases.

[7]  M. Iseman.  Treatment of multidrug-resistant tuberculosis. , 1993, The New England journal of medicine.

[8]  M. Iseman,et al.  PITFALLS IN THE CARE OF PATIENTS WITH TUBERCULOSIS: COMMON ERRORS AND THEIR ASSOCIATION WITH THE ACQUISITION OF DRUG RESISTANCE , 1993, JAMA.

[9]  E. Nardell.  Beyond four drugs. Public health policy and the treatment of the individual patient with tuberculosis. , 1993, The American review of respiratory disease.

[10]  J. T. Crawford,et al.  The resurgence of tuberculosis: is your laboratory ready? , 1993, Journal of clinical microbiology.

[11]  M. Iseman,et al.  Directly observed treatment of tuberculosis. We can't afford not to try it. , 1993, The New England journal of medicine.

[12]  L. Ackerson,et al.  Treatment of 171 patients with pulmonary tuberculosis resistant to isoniazid and rifampin. , 1993, The New England journal of medicine.

[13]  T. Frieden,et al.  The emergence of drug-resistant tuberculosis in New York City. , 1993, The New England journal of medicine.

[14]  J. T. Crawford,et al.  Hospital outbreak of multidrug-resistant Mycobacterium tuberculosis infections. Factors in transmission to staff and HIV-infected patients. , 1992, JAMA.

[15]  Christopher J. L. Murray,et al.  Tuberculosis: Commentary on a Reemergent Killer , 1992, Science.

[16]  D. Snider,et al.  Multidrug-resistant Tuberculosis , 1992, Annals of Internal Medicine.

[17]  J. T. Crawford,et al.  Nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis. A risk to patients and health care workers. , 1992, Annals of internal medicine.

[18]  J. T. Crawford,et al.  An outbreak of multidrug-resistant tuberculosis among hospitalized patients with the acquired immunodeficiency syndrome. , 1992, The New England journal of medicine.

[19]  D. Snider,et al.  Tuberculosis morbidity in the United States: final data, 1990. , 1991, MMWR. CDC surveillance summaries : Morbidity and mortality weekly report. CDC surveillance summaries.

[20]  L. Reichman.  The U-shaped curve of concern. , 1991, American Review of Respiratory Disease.

[21]  K. Brudney,et al.  Resurgent Tuberculosis in New York City: Human Immunodeficiency Virus, Homelessness, and the Decline of Tuberculosis Control Programs , 1991, The American review of respiratory disease.

[22]  D. Snider,et al.  Drug-resistant tuberculosis , 1988, Clinical Tuberculosis.

[23]  Dowdle Wr,et al.  A strategic plan for the elimination of tuberculosis in the United States. , 1989, MMWR. Morbidity and mortality weekly report.

[24]  D. Snider,et al.  Recurrent tuberculosis: why do patients develop disease again? A United States Public Health Service cooperative survey. , 1988, American Journal of Public Health.

[25]  P. Barnes.  The influence of epidemiologic factors on drug resistance rates in tuberculosis. , 1987, The American review of respiratory disease.

[26]  P. Davidson.  Drug resistance and the selection of therapy for tuberculosis. , 1987, The American review of respiratory disease.

[27]  D. Mitchison.  The action of antituberculosis drugs in short-course chemotherapy. , 1985, Tubercle.

[28]  D. Snider,et al.  Tuberculosis in the United States , 1989, Nature.

[29]  P. P. Jacobs.  THE CONTROL OF TUBERCULOSIS IN THE UNITED STATES , 1932 .