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Extensively drug-resistant tuberculosis in california, 1993-2006.
Clin Infect Dis. 2008 Aug 15; 47(4):450-7.CI

Abstract

BACKGROUND

Extensively drug-resistant (XDR) tuberculosis (TB) is a global public health emergency. We investigated the characteristics and extent of XDR TB in California to inform public health interventions.

METHODS

XDR TB was defined as TB with resistance to at least isoniazid, rifampin, a fluoroquinolone, and 1 of 3 injectable second-line drugs (amikacin, kanamycin, or capreomycin). Pre-XDR TB was defined as TB with resistance to isoniazid and rifampin and either a fluoroquinolone or second-line injectable agent but not both. We analyzed TB case reports submitted to the state TB registry for the period 1993-2006. Local health departments and the state TB laboratory were queried to ensure complete drug susceptibility reporting.

RESULTS

Among 424 multidrug-resistant (MDR) TB cases with complete drug susceptibility reporting, 18 (4.2%) were extensively drug resistant, and 77 (18%) were pre-extensively drug resistant. The proportion of pre-XDR TB cases increased over time, from 7% in 1993 to 32% in 2005 (P = .02)). Among XDR TB cases, 83% of cases involved foreign-born patients, and 43% were diagnosed in patients within 6 months after arrival in the United States. Mexico was the most common country of origin. Five cases (29%) of XDR TB were acquired during therapy in California. All patients with XDR TB had pulmonary disease, and most had prolonged infectious periods; the median time for conversion of sputum culture results was 195 days. Among 17 patients with known outcomes, 7 (41.2%) completed therapy, 5 (29.4%) moved, and 5 (29.4%) died. One patient continues to receive treatment.

CONCLUSIONS

XDR TB and pre-XDR TB cases comprise a substantial fraction of MDR TB cases in California, indicating the need for interventions that improve surveillance, directly observed therapy, and rapid drug susceptibility testing and reporting.

Authors+Show Affiliations

Department of Pediatrics, Division of Infectious Disease, University of California, San Francisco, California, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

18616396

Citation

Banerjee, Ritu, et al. "Extensively Drug-resistant Tuberculosis in California, 1993-2006." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 47, no. 4, 2008, pp. 450-7.
Banerjee R, Allen J, Westenhouse J, et al. Extensively drug-resistant tuberculosis in california, 1993-2006. Clin Infect Dis. 2008;47(4):450-7.
Banerjee, R., Allen, J., Westenhouse, J., Oh, P., Elms, W., Desmond, E., Nitta, A., Royce, S., & Flood, J. (2008). Extensively drug-resistant tuberculosis in california, 1993-2006. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 47(4), 450-7. https://doi.org/10.1086/590009
Banerjee R, et al. Extensively Drug-resistant Tuberculosis in California, 1993-2006. Clin Infect Dis. 2008 Aug 15;47(4):450-7. PubMed PMID: 18616396.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Extensively drug-resistant tuberculosis in california, 1993-2006. AU - Banerjee,Ritu, AU - Allen,Jennifer, AU - Westenhouse,Janice, AU - Oh,Peter, AU - Elms,William, AU - Desmond,Ed, AU - Nitta,Annette, AU - Royce,Sarah, AU - Flood,Jennifer, PY - 2008/7/12/pubmed PY - 2008/8/30/medline PY - 2008/7/12/entrez SP - 450 EP - 7 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin Infect Dis VL - 47 IS - 4 N2 - BACKGROUND: Extensively drug-resistant (XDR) tuberculosis (TB) is a global public health emergency. We investigated the characteristics and extent of XDR TB in California to inform public health interventions. METHODS: XDR TB was defined as TB with resistance to at least isoniazid, rifampin, a fluoroquinolone, and 1 of 3 injectable second-line drugs (amikacin, kanamycin, or capreomycin). Pre-XDR TB was defined as TB with resistance to isoniazid and rifampin and either a fluoroquinolone or second-line injectable agent but not both. We analyzed TB case reports submitted to the state TB registry for the period 1993-2006. Local health departments and the state TB laboratory were queried to ensure complete drug susceptibility reporting. RESULTS: Among 424 multidrug-resistant (MDR) TB cases with complete drug susceptibility reporting, 18 (4.2%) were extensively drug resistant, and 77 (18%) were pre-extensively drug resistant. The proportion of pre-XDR TB cases increased over time, from 7% in 1993 to 32% in 2005 (P = .02)). Among XDR TB cases, 83% of cases involved foreign-born patients, and 43% were diagnosed in patients within 6 months after arrival in the United States. Mexico was the most common country of origin. Five cases (29%) of XDR TB were acquired during therapy in California. All patients with XDR TB had pulmonary disease, and most had prolonged infectious periods; the median time for conversion of sputum culture results was 195 days. Among 17 patients with known outcomes, 7 (41.2%) completed therapy, 5 (29.4%) moved, and 5 (29.4%) died. One patient continues to receive treatment. CONCLUSIONS: XDR TB and pre-XDR TB cases comprise a substantial fraction of MDR TB cases in California, indicating the need for interventions that improve surveillance, directly observed therapy, and rapid drug susceptibility testing and reporting. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/18616396/Extensively_drug_resistant_tuberculosis_in_california_1993_2006_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1086/590009 DB - PRIME DP - Unbound Medicine ER -