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Trends in drug-resistant tuberculosis in the United States, 1993-1996.
JAMA. 1997 Sep 10; 278(10):833-7.JAMA

Abstract

CONTEXT

With the resurgence of tuberculosis (TB) disease in the late 1980s and early 1990s in the United States, multidrug-resistant (MDR) TB emerged as a serious challenge to TB control. In response, the Centers for Disease Control and Prevention in 1993 added drug susceptibility test results to the information collected for the national surveillance system to monitor trends in drug resistance.

OBJECTIVE

To determine the extent of drug-resistant tuberculosis (TB) in the United States.

DESIGN

Descriptive analysis of TB surveillance data.

STUDY POPULATION

Patients reported to the national TB surveillance system as confirmed TB cases with culture-positive disease from 1993 through 1996 by the 50 states, New York City, and the District of Columbia (DC).

MAIN OUTCOME MEASURE

Percentage of case patients with culture-positive disease whose isolates are resistant to specific anti-TB drugs.

RESULTS

Overall resistance to at least isoniazid was 8.4%; rifampin, 3.0%; both isoniazid and rifampin (ie, MDR TB), 2.2%; pyrazinamide, 3.0%; streptomycin, 6.2%; and ethambutol hydrochloride, 2.2%. Rates of resistance were significantly higher for case patients with a prior TB episode. Among those without prior TB, isoniazid resistance of 4% or more was found in 41 states, New York City, and DC. A total of 1457 MDR TB cases were reported from 42 states, New York City, and DC; however, 38% were reported from New York City. Rates of isoniazid and streptomycin resistance were higher for cases among foreign-born compared with US-born patients [corrected] but rates of rifampin resistance and MDR TB were similar. Among US-born patients, resistance to first-line drugs, particularly rifampin monoresistance, was significantly higher among those with human immunodeficiency virus (HIV) infection.

CONCLUSIONS

Compared with recent US surveys in 1991 and 1992, isoniazid resistance has remained relatively stable. In addition, the percentage of MDR TB has decreased, although the national trend was significantly influenced by the marked decrease in New York City. Foreign-born and HIV-positive patients and those with prior TB have higher rates of resistance. The widespread extent of isoniazid resistance confirms the need for drug susceptibility testing to guide optimal treatment of patients with culture-positive disease.

Authors+Show Affiliations

Division of Tuberculosis Elimination, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

9293991

Citation

Moore, M, et al. "Trends in Drug-resistant Tuberculosis in the United States, 1993-1996." JAMA, vol. 278, no. 10, 1997, pp. 833-7.
Moore M, Onorato IM, McCray E, et al. Trends in drug-resistant tuberculosis in the United States, 1993-1996. JAMA. 1997;278(10):833-7.
Moore, M., Onorato, I. M., McCray, E., & Castro, K. G. (1997). Trends in drug-resistant tuberculosis in the United States, 1993-1996. JAMA, 278(10), 833-7.
Moore M, et al. Trends in Drug-resistant Tuberculosis in the United States, 1993-1996. JAMA. 1997 Sep 10;278(10):833-7. PubMed PMID: 9293991.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Trends in drug-resistant tuberculosis in the United States, 1993-1996. AU - Moore,M, AU - Onorato,I M, AU - McCray,E, AU - Castro,K G, PY - 1997/9/18/pubmed PY - 1997/9/18/medline PY - 1997/9/18/entrez SP - 833 EP - 7 JF - JAMA JO - JAMA VL - 278 IS - 10 N2 - CONTEXT: With the resurgence of tuberculosis (TB) disease in the late 1980s and early 1990s in the United States, multidrug-resistant (MDR) TB emerged as a serious challenge to TB control. In response, the Centers for Disease Control and Prevention in 1993 added drug susceptibility test results to the information collected for the national surveillance system to monitor trends in drug resistance. OBJECTIVE: To determine the extent of drug-resistant tuberculosis (TB) in the United States. DESIGN: Descriptive analysis of TB surveillance data. STUDY POPULATION: Patients reported to the national TB surveillance system as confirmed TB cases with culture-positive disease from 1993 through 1996 by the 50 states, New York City, and the District of Columbia (DC). MAIN OUTCOME MEASURE: Percentage of case patients with culture-positive disease whose isolates are resistant to specific anti-TB drugs. RESULTS: Overall resistance to at least isoniazid was 8.4%; rifampin, 3.0%; both isoniazid and rifampin (ie, MDR TB), 2.2%; pyrazinamide, 3.0%; streptomycin, 6.2%; and ethambutol hydrochloride, 2.2%. Rates of resistance were significantly higher for case patients with a prior TB episode. Among those without prior TB, isoniazid resistance of 4% or more was found in 41 states, New York City, and DC. A total of 1457 MDR TB cases were reported from 42 states, New York City, and DC; however, 38% were reported from New York City. Rates of isoniazid and streptomycin resistance were higher for cases among foreign-born compared with US-born patients [corrected] but rates of rifampin resistance and MDR TB were similar. Among US-born patients, resistance to first-line drugs, particularly rifampin monoresistance, was significantly higher among those with human immunodeficiency virus (HIV) infection. CONCLUSIONS: Compared with recent US surveys in 1991 and 1992, isoniazid resistance has remained relatively stable. In addition, the percentage of MDR TB has decreased, although the national trend was significantly influenced by the marked decrease in New York City. Foreign-born and HIV-positive patients and those with prior TB have higher rates of resistance. The widespread extent of isoniazid resistance confirms the need for drug susceptibility testing to guide optimal treatment of patients with culture-positive disease. SN - 0098-7484 UR - https://www.unboundmedicine.com/medline/citation/9293991/Trends_in_drug_resistant_tuberculosis_in_the_United_States_1993_1996_ L2 - https://jamanetwork.com/journals/jama/fullarticle/vol/278/pg/833 DB - PRIME DP - Unbound Medicine ER -