An outbreak of tuberculosis caused by multiple-drug-resistant tubercle bacilli among patients with HIV infection.
OBJECTIVE
To evaluate a nosocomial outbreak of tuberculosis caused by multiple-drug-resistant bacilli among patients with tuberculosis and HIV infection.


METHODS
A case-control study.


METHODS
Patients with HIV infection and culture-proven tuberculosis.


METHODS
Patient characteristics, date of diagnoses of HIV infection and disease, date of diagnosis of tuberculosis, Mycobacterium tuberculosis susceptibility results, and medical center contact.


RESULTS
Sixty-two patients who had tuberculosis caused by multiple-drug-resistant bacilli (cases) and 55 patients who had tuberculosis caused by susceptible or single-drug-resistant bacilli (controls) were identified. Controls were more likely to be black (odds ratio, 0.4; 95% CI, 0.2 to 0.9) or Haitian (odds ratio, 0.2; CI, 0.1 to 0.6) compared with cases, who were more likely to be homosexual men (odds ratio, 2.9; CI, 1.3 to 6.4). Forty-four cases (71%) had previous contact with an HIV clinic compared with 15 controls (27%) (P less than 0.0001). Cases were more likely to have had AIDS (odds ratio, 7.7; CI, 1.5 to 53.7), to have been hospitalized on an HIV ward (odds ratio, 8.3; CI, 2.3 to 29.7), to have been seen in an HIV clinic (odds ratio, 7.8; CI, 3.4 to 18.1), to have received intravenous therapy in an HIV clinic (odds ratio, 13.0; CI, 4.6 to 37.0), or to have received inhalation pentamidine in an HIV clinic before a diagnosis of tuberculosis was made. Multiple logistic regression analysis showed that a diagnosis of AIDS (odds ratio, 11.2; CI, 3.1 to 40.6) and HIV clinic visits (odds ratio, 13.0; CI, 2.7 to 63.7) before a diagnosis of tuberculosis were significantly associated with tuberculosis caused by multiple-drug-resistant bacilli. Using susceptibility patterns and appointment dates, we found that 22 cases had previous contact with a person who had tuberculosis caused by multiple-drug-resistant bacilli in the HIV clinic.


CONCLUSIONS
Nosocomial transmission of M. tuberculosis from other HIV-infected patients with tuberculosis caused by multiple-drug-resistant bacilli can occur. These findings have serious public health implications and demand strict adherence to acid-fast bacilli isolation precautions.
Fischl
M A
MA
University of Miami School of Medicine, Department of Medicine, FL 33101.
Uttamchandani
R B
RB
Daikos
G L
GL
Poblete
R B
RB
Moreno
J N
JN
Reyes
R R
RR
Boota
A M
AM
Thompson
L M
LM
Cleary
T J
TJ
Lai
S
S
D000328:Adult; D000995:Antitubercular Agents / Q000494:pharmacology*; D016022:Case-Control Studies; D003428:Cross Infection / Q000150:complications / Q000453:epidemiology / Q000382:microbiology* / Q000635:transmission; D004196:Disease Outbreaks; D004352:Drug Resistance, Microbial; D005260:Female; D005431:Florida / Q000453:epidemiology; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D009169:Mycobacterium tuberculosis / Q000187:drug effects*; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000453:epidemiology / Q000382:microbiology* / Q000635:transmission
D000995:Antitubercular Agents