title: A city-wide outbreak of a multiple-drug-resistant strain of Mycobacterium tuberculosis in New York.
abstract: METHODS
  Incident patients with active tuberculosis (TB) resistant to two or more drugs in New York City hospitals in 1992.
  
  
  OBJECTIVE
  To examine the New York-wide distribution of Public Health Research Institute (PHRI) strain W of Mycobacterium tuberculosis, an extremely drug-resistant strain identified by a 17-band Southern hybridization pattern using IS6110, during the peak tuberculosis year of 1992. We also compared strain W with other strains frequently observed in New York.
  
  
  METHODS
  Blinded retrospective study of stored M. tuberculosis cultures by restriction fragment length polymorphism (RFLP) DNA fingerprinting, and chart review.
  
  
  RESULTS
  We found 112 cultures with the strain W fingerprint and 8 variants in 21 hospitals among incident patients hospitalized in 1992. Almost all isolates were resistant to four first-line drugs and kanamycin. This single strain made up at least 22% of New York City multiple-drug-resistant (MDR) TB in 1992, far more than any other strain. Almost all W-strain cases were acquired immune deficiency syndrome (AIDS) patients. The cluster is the most drug-resistant cluster identified in New York and the largest IS6110 fingerprint cluster identified anywhere to date.
  
  
  CONCLUSIONS
  Because recommended four-drug therapy will not sterilise this very resistant strain, there was a city-wide nosocomial outbreak of W-strain TB in the early 1990s among New York AIDS patients. Other frequently seen strains were either also very resistant, or, surprisingly, pansusceptible. Individual MDR strains can be spread widely in situations where AIDS and TB are both common.
authors.affiliation: Department of Epidemiology and Biostatistics, University of California, San Francisco 94143-1347, USA.
authors.forename: A R
authors.initials: AR
authors.lastname: Moss
authors.forename: D
authors.initials: D
authors.lastname: Alland
authors.forename: E
authors.initials: E
authors.lastname: Telzak
authors.forename: D
authors.initials: D
authors.lastname: Hewlett
authors.forename: V
authors.initials: V
authors.lastname: Sharp
authors.forename: P
authors.initials: P
authors.lastname: Chiliade
authors.forename: V
authors.initials: V
authors.lastname: LaBombardi
authors.forename: D
authors.initials: D
authors.lastname: Kabus
authors.forename: B
authors.initials: B
authors.lastname: Hanna
authors.forename: L
authors.initials: L
authors.lastname: Palumbo
authors.forename: K
authors.initials: K
authors.lastname: Brudney
authors.forename: A
authors.initials: A
authors.lastname: Weltman
authors.forename: K
authors.initials: K
authors.lastname: Stoeckle
authors.forename: K
authors.initials: K
authors.lastname: Chirgwin
authors.forename: M
authors.initials: M
authors.lastname: Simberkoff
authors.forename: S
authors.initials: S
authors.lastname: Moghazeh
authors.forename: W
authors.initials: W
authors.lastname: Eisner
authors.forename: M
authors.initials: M
authors.lastname: Lutfey
authors.forename: B
authors.initials: B
authors.lastname: Kreiswirth
mesh_terms: D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000494:pharmacology / Q000627:therapeutic use; D015373:Bacterial Typing Techniques; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D018432:Drug Resistance, Multiple; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000145:classification* / Q000187:drug effects; D009519:New York City / Q000453:epidemiology; D012189:Retrospective Studies; D013045:Species Specificity; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology* / Q000382:microbiology
chemical_list: D000995:Antitubercular Agents