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Tuberculosis Susceptibility Patterns, Predictors of Multidrug Resistance, and Implications for Initial Therapeutic Regimens at a New York City Hospital

Tuberculosis Susceptibility Patterns, Predictors of Multidrug Resistance, and Implications for... Abstract Background: Multidrug resistance has complicated tuberculosis therapy. We studied antibiotic susceptibilities of Mycobacterium tuberculosis and predictors of multidrug resistance to assist in determining initial drug regimens. Methods: We conducted a case-control study based on chart review of patients with and without multidrug-resistant tuberculosis, including outpatients and inpatients with culture-proved tuberculosis seen at a large New York, NY, hospital during 1991 and 1992. Patient characteristics studied included serologic findings for human immunodeficiency virus and the presence of the acquired immunodeficiency syndrome. Descriptive analysis considered potential initial drug regimens. A theoretically effective regimen was assumed to contain at least two drugs to which an isolate was susceptible. Results: For 172 patients, 28.5% of isolates were resistant to isoniazid, at least 20.9% to rifampin, 15.7% to ethambutol, 8.1% to pyrazinamide, 18.6% to streptomycin, 9.9% to ethionamide, 8.1% to kanamycin, and none to capreomycin, cycloserine, and ciprofloxacin; 18.6% were resistant to both isoniazid and rifampin. Chart review of 159 patients showed that acquired immunodeficiency syndrome, human immunodeficiency virus seropositivity, female gender, residence in the Bronx, and race were associated with multidrug resistance. The four-drug regimen of isoniazid, rifampin, ethambutol, and pyrazinamide was theoretically effective for 81% to 85% of patients. No subset of patients would have a markedly better theoretical benefit from that regimen. Only five- or six-drug regimens that used the combinations of capreomycin plus ciprofloxacin, capreomycin plus cycloserine, ciprofloxacin plus cycloserine, or all three drugs together theoretically offered significantly higher effectiveness. Conclusions: Tuberculosis isolates at our hospital have a high frequency of multidrug resistance. Only five- or six-drug regimens are theoretically adequate as initial therapy for our patients.(Arch Intern Med. 1994;154:2161-2167) References 1. Centers for Disease Control. National action plan to combat multidrug-resistant tuberculosis . MMWR Morb Mortal Wkly Rep. 1992;41( (RR-11) ):1-48. 2. Frieden TR, Sterling T, Pablos-Mendez A, Kilburn JO, Cauthen GM, Dooley SW. The emergence of drug-resistant tuberculosis in New York City . N Engl J Med . 1993;328:521-526.Crossref 3. Centers for Disease Control. Nosocomial transmission of multidrug-resistant TB to health-care workers and HIV-infected patients in an urban hospital— Florida . MMWR Morb Mortal Wkly Rep . 1990;39:718-722. 4. Centers for Disease Control. Nosocomial transmission of multidrug-resistant tuberculosis among HIV-infected persons—Florida and New York, 19881991 . MMWR Morb Mortal Wkly Rep. 1991;40:585-591. 5. Edlin BR, Tokars JI, Grieco MH, et al. An outbreak of multidrug-resistant tuberculosis among hospitalized patients with the acquired immunodeficiency syndrome . N Engl J Med. 1992;326:1514-1521.Crossref 6. Fischl MA, Uttamchandani RB, Daikos GI, et al. An outbreak of tuberculosis caused by multiple-drug-resistant tubercle bacilli among patients with HIV infection . Ann Intern Med. 1992;117:177-183.Crossref 7. Pearson ML, Jereb JA, Frieden TR, et al. Nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis: a risk to patients and health care workers . Ann Intern Med. 1992;117:191-196.Crossref 8. Braun MM, Truman BI, Maguire B, et al. Increasing incidence of tuberculosis in a prison inmate population: association with HIV infection . JAMA. 1989; 261:393-397.Crossref 9. Snider DE, Hutton MD. Tuberculosis in correctional institutions . JAMA. 1989; 261:436-437.Crossref 10. Centers for Disease Control. Drug-resistant tuberculosis among the homeless— Boston . MMWR Morb Mortal Wkly Rep. 1985;34:429-431. 11. Nardell E, McInnis B, Thomas B, Weidhaas S. Exogenous reinfection with tuberculosis in a shelter for the homeless . N Engl J Med. 1986;315:1570-1575.Crossref 12. Centers for Disease Control. Tuberculosis outbreak among persons in a residential facility for HIV-infected persons—San Francisco . MMWR Morb Mortal Wkly Rep. 1991;40:649-652. 13. New York City Department of Health. Health Commissioner Announces Results of a Study on Drug-Resistant Tuberculosis . New York, NY: Dept of Health; (November 19) , 1991. 14. Schafer RW, Chirgwin KD, Glatt AE, Dahdouh MA, Landesman SH, Suster B. HIV prevalence, immunosuppression, and drug resistance in patients with tuberculosis in an area endemic for AIDS . AIDS. 1991;5:399-405.Crossref 15. Chawla PK, Klapper PJ, Kamholz SL, Pollack AH, Heurich AE. Drug-resistant tuberculosis in an urban population including patients at risk for human immunodeficiency virus infection . Am Rev Respir Dis. 1992;146:280-284.Crossref 16. Long R, Scalcini M, Manfreda J, et al. Impact of human immunodeficiency virus type 1 on tuberculosis in rural Haiti . Am Rev Respir Dis. 1991;143:69-73.Crossref 17. Kanengiser L, Mayo P, Aranda CM. Tuberculosis drug resistance patterns in intravenous drug abusers . Chest. 1988;94:23S. Abstract. 18. Miro A, Gibilaro E, Powell S, Kamholz S. Primary antituberculosis drug resistance among patients at risk for AIDS . Am Rev Respir Dis. 1990;141:A267. Abstract. 19. Pablos-Mendez A, Raviglione MC, Battan R. Drug-resistant tuberculosis in AIDS . Chest . 1990;97:511-512.Crossref 20. Barnes PF. The influence of epidemiologic factors on drug resistance rates in tuberculosis . Am Rev Respir Dis. 1987;36:325-328.Crossref 21. Centers for Disease Control. Revision of the CDC surveillance case definition of acquired immunodeficiency syndrome . MMWR Morb Mortal Wkly Rep. 1987; 36( (suppl 1) ):3S-15S. 22. Centers for Disease Control and Prevention. 1993 Revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults . MMWR Morb Mortal Wkly Rep. 1992;41( (RR-17) ):1-19. 23. Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease . J Natl Cancer Inst. 1959;22:718-748. 24. Robins J, Greenland S, Breslow NE. A general estimator for the variance of the Mantel-Haenszel odds ratio . Am J Epidemiol. 1986;124:719-723. 25. Brudney K, Dobkin J. Resurgent tuberculosis in New York City: human immunodeficiency virus, homelessness, and the decline of tuberculosis control programs . Am Rev Respir Dis. 1991;144:745-749.Crossref 26. Di Perri G, Cruciani M, Danzi MC, et al. Nosocomial epidemic of active tuberculosis among HIV-infected patients . Lancet. 1989;2:1502-1504. 27. Daley CL, Small PM, Schecter GF, et al. An outbreak of tuberculosis with accelerated progression among persons infected with the human immunodeficiency virus . N Engl J Med. 1992;326:231-235.Crossref 28. Dooley SW, Villarino ME, Lawrence M, et al. Nosocomial transmission of tuberculosis in a hospital unit for HIV-infected patients . JAMA. 1992;267:2632-2635.Crossref 29. Goodman RA, Smith JD, Kubica GP, Dougherty EM, Sikes RK. Nosocomial mycobacterial pseudoinfection in a Georgia hospital . Infect Control. 1984;5: 573-576. 30. Vannier AM, Tarrand JJ, Murray PR. Mycobacterial cross contamination during radiometric culturing . J Clin Microbiol. 1988;26:1867-1868. 31. Truffot-Pernot C, Ji B, Grosset J. Activities of pefloxacin and ofloxacin against mycobacteria: in vitro and mouse experiments . Tubercle. 1991;72:57-64.Crossref 32. Ji B, Truffot-Pernot C, Grosset J. In vitro and in vivo activities of sparfloxacin (AT-4140) against Mycobacterium tuberculosis . Tubercle. 1991;72:181-186.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Tuberculosis Susceptibility Patterns, Predictors of Multidrug Resistance, and Implications for Initial Therapeutic Regimens at a New York City Hospital

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Publisher
American Medical Association
Copyright
Copyright © 1994 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1994.00420190058007
Publisher site
See Article on Publisher Site

Abstract

Abstract Background: Multidrug resistance has complicated tuberculosis therapy. We studied antibiotic susceptibilities of Mycobacterium tuberculosis and predictors of multidrug resistance to assist in determining initial drug regimens. Methods: We conducted a case-control study based on chart review of patients with and without multidrug-resistant tuberculosis, including outpatients and inpatients with culture-proved tuberculosis seen at a large New York, NY, hospital during 1991 and 1992. Patient characteristics studied included serologic findings for human immunodeficiency virus and the presence of the acquired immunodeficiency syndrome. Descriptive analysis considered potential initial drug regimens. A theoretically effective regimen was assumed to contain at least two drugs to which an isolate was susceptible. Results: For 172 patients, 28.5% of isolates were resistant to isoniazid, at least 20.9% to rifampin, 15.7% to ethambutol, 8.1% to pyrazinamide, 18.6% to streptomycin, 9.9% to ethionamide, 8.1% to kanamycin, and none to capreomycin, cycloserine, and ciprofloxacin; 18.6% were resistant to both isoniazid and rifampin. Chart review of 159 patients showed that acquired immunodeficiency syndrome, human immunodeficiency virus seropositivity, female gender, residence in the Bronx, and race were associated with multidrug resistance. The four-drug regimen of isoniazid, rifampin, ethambutol, and pyrazinamide was theoretically effective for 81% to 85% of patients. No subset of patients would have a markedly better theoretical benefit from that regimen. Only five- or six-drug regimens that used the combinations of capreomycin plus ciprofloxacin, capreomycin plus cycloserine, ciprofloxacin plus cycloserine, or all three drugs together theoretically offered significantly higher effectiveness. Conclusions: Tuberculosis isolates at our hospital have a high frequency of multidrug resistance. Only five- or six-drug regimens are theoretically adequate as initial therapy for our patients.(Arch Intern Med. 1994;154:2161-2167) References 1. Centers for Disease Control. National action plan to combat multidrug-resistant tuberculosis . MMWR Morb Mortal Wkly Rep. 1992;41( (RR-11) ):1-48. 2. Frieden TR, Sterling T, Pablos-Mendez A, Kilburn JO, Cauthen GM, Dooley SW. The emergence of drug-resistant tuberculosis in New York City . N Engl J Med . 1993;328:521-526.Crossref 3. Centers for Disease Control. Nosocomial transmission of multidrug-resistant TB to health-care workers and HIV-infected patients in an urban hospital— Florida . MMWR Morb Mortal Wkly Rep . 1990;39:718-722. 4. Centers for Disease Control. Nosocomial transmission of multidrug-resistant tuberculosis among HIV-infected persons—Florida and New York, 19881991 . MMWR Morb Mortal Wkly Rep. 1991;40:585-591. 5. Edlin BR, Tokars JI, Grieco MH, et al. An outbreak of multidrug-resistant tuberculosis among hospitalized patients with the acquired immunodeficiency syndrome . N Engl J Med. 1992;326:1514-1521.Crossref 6. Fischl MA, Uttamchandani RB, Daikos GI, et al. An outbreak of tuberculosis caused by multiple-drug-resistant tubercle bacilli among patients with HIV infection . Ann Intern Med. 1992;117:177-183.Crossref 7. Pearson ML, Jereb JA, Frieden TR, et al. Nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis: a risk to patients and health care workers . Ann Intern Med. 1992;117:191-196.Crossref 8. Braun MM, Truman BI, Maguire B, et al. Increasing incidence of tuberculosis in a prison inmate population: association with HIV infection . JAMA. 1989; 261:393-397.Crossref 9. Snider DE, Hutton MD. Tuberculosis in correctional institutions . JAMA. 1989; 261:436-437.Crossref 10. Centers for Disease Control. Drug-resistant tuberculosis among the homeless— Boston . MMWR Morb Mortal Wkly Rep. 1985;34:429-431. 11. Nardell E, McInnis B, Thomas B, Weidhaas S. Exogenous reinfection with tuberculosis in a shelter for the homeless . N Engl J Med. 1986;315:1570-1575.Crossref 12. Centers for Disease Control. Tuberculosis outbreak among persons in a residential facility for HIV-infected persons—San Francisco . MMWR Morb Mortal Wkly Rep. 1991;40:649-652. 13. New York City Department of Health. Health Commissioner Announces Results of a Study on Drug-Resistant Tuberculosis . New York, NY: Dept of Health; (November 19) , 1991. 14. Schafer RW, Chirgwin KD, Glatt AE, Dahdouh MA, Landesman SH, Suster B. HIV prevalence, immunosuppression, and drug resistance in patients with tuberculosis in an area endemic for AIDS . AIDS. 1991;5:399-405.Crossref 15. Chawla PK, Klapper PJ, Kamholz SL, Pollack AH, Heurich AE. Drug-resistant tuberculosis in an urban population including patients at risk for human immunodeficiency virus infection . Am Rev Respir Dis. 1992;146:280-284.Crossref 16. Long R, Scalcini M, Manfreda J, et al. Impact of human immunodeficiency virus type 1 on tuberculosis in rural Haiti . Am Rev Respir Dis. 1991;143:69-73.Crossref 17. Kanengiser L, Mayo P, Aranda CM. Tuberculosis drug resistance patterns in intravenous drug abusers . Chest. 1988;94:23S. Abstract. 18. Miro A, Gibilaro E, Powell S, Kamholz S. Primary antituberculosis drug resistance among patients at risk for AIDS . Am Rev Respir Dis. 1990;141:A267. Abstract. 19. Pablos-Mendez A, Raviglione MC, Battan R. Drug-resistant tuberculosis in AIDS . Chest . 1990;97:511-512.Crossref 20. Barnes PF. The influence of epidemiologic factors on drug resistance rates in tuberculosis . Am Rev Respir Dis. 1987;36:325-328.Crossref 21. Centers for Disease Control. Revision of the CDC surveillance case definition of acquired immunodeficiency syndrome . MMWR Morb Mortal Wkly Rep. 1987; 36( (suppl 1) ):3S-15S. 22. Centers for Disease Control and Prevention. 1993 Revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults . MMWR Morb Mortal Wkly Rep. 1992;41( (RR-17) ):1-19. 23. Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease . J Natl Cancer Inst. 1959;22:718-748. 24. Robins J, Greenland S, Breslow NE. A general estimator for the variance of the Mantel-Haenszel odds ratio . Am J Epidemiol. 1986;124:719-723. 25. Brudney K, Dobkin J. Resurgent tuberculosis in New York City: human immunodeficiency virus, homelessness, and the decline of tuberculosis control programs . Am Rev Respir Dis. 1991;144:745-749.Crossref 26. Di Perri G, Cruciani M, Danzi MC, et al. Nosocomial epidemic of active tuberculosis among HIV-infected patients . Lancet. 1989;2:1502-1504. 27. Daley CL, Small PM, Schecter GF, et al. An outbreak of tuberculosis with accelerated progression among persons infected with the human immunodeficiency virus . N Engl J Med. 1992;326:231-235.Crossref 28. Dooley SW, Villarino ME, Lawrence M, et al. Nosocomial transmission of tuberculosis in a hospital unit for HIV-infected patients . JAMA. 1992;267:2632-2635.Crossref 29. Goodman RA, Smith JD, Kubica GP, Dougherty EM, Sikes RK. Nosocomial mycobacterial pseudoinfection in a Georgia hospital . Infect Control. 1984;5: 573-576. 30. Vannier AM, Tarrand JJ, Murray PR. Mycobacterial cross contamination during radiometric culturing . J Clin Microbiol. 1988;26:1867-1868. 31. Truffot-Pernot C, Ji B, Grosset J. Activities of pefloxacin and ofloxacin against mycobacteria: in vitro and mouse experiments . Tubercle. 1991;72:57-64.Crossref 32. Ji B, Truffot-Pernot C, Grosset J. In vitro and in vivo activities of sparfloxacin (AT-4140) against Mycobacterium tuberculosis . Tubercle. 1991;72:181-186.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Oct 10, 1994

References