title: An outbreak of tuberculosis caused by multiple-drug-resistant tubercle bacilli among patients with HIV infection.
abstract: 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.
authors.affiliation: University of Miami School of Medicine, Department of Medicine, FL 33101.
authors.forename: M A
authors.initials: MA
authors.lastname: Fischl
authors.forename: R B
authors.initials: RB
authors.lastname: Uttamchandani
authors.forename: G L
authors.initials: GL
authors.lastname: Daikos
authors.forename: R B
authors.initials: RB
authors.lastname: Poblete
authors.forename: J N
authors.initials: JN
authors.lastname: Moreno
authors.forename: R R
authors.initials: RR
authors.lastname: Reyes
authors.forename: A M
authors.initials: AM
authors.lastname: Boota
authors.forename: L M
authors.initials: LM
authors.lastname: Thompson
authors.forename: T J
authors.initials: TJ
authors.lastname: Cleary
authors.forename: S
authors.initials: S
authors.lastname: Lai
mesh_terms: 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
chemical_list: D000995:Antitubercular Agents