title: Risk factors for nosocomial transmission of multidrug-resistant tuberculosis due to Mycobacterium bovis among HIV-infected patients.
abstract: OBJECTIVE
  To identify risk factors for transmission of multidrug-resistant tuberculosis (MDR-TB) among hospitalized human immunodeficiency virus (HIV) infected patients exposed during a nosocomial outbreak.
  
  
  METHODS
  Case control study. Cases were HIV-infected patients with MDR-TB due to Mycobacterium bovis (MDR-TBMb) who acquired the disease after exposure to an MDR-TBMb patient in an hospital ward. Controls were HIV-infected patients exposed to a case of MDR-TBMb in an hospital ward but who did not develop MDR-TBMb during the follow-up.
  
  
  RESULTS
  Nineteen cases and 31 controls were included. CD4 cell counts were significantly lower among cases. Exposure in the infectious diseases ward or exposure to the index patient were associated with development of MDR-TBMb, while exposure during a single-room hospital stay and exposure in the respiratory isolation ward were associated with non-development of MDR-TBMb. A multiple regression logistic model showed that only a CD4 cell count below 50/microL and exposure to the index patient increased the risk of developing MDR-TBMb (P < 0.05). Hospitalization in a single room seemed to protect HIV-infected patients from developing nosocomial MDR-TBMb (P = 0.052).
  
  
  CONCLUSIONS
  Over classic risk factors, such as length of exposure or sharing a room with a case, severe immunosuppression independently increases the risk of MDR-TB transmission in the context of a nosocomial MDR-TB outbreak among HIV-infected patients. This information must be considered in the management of tuberculosis outbreaks. Patients with CD4 cell counts below 50/microL should be the principal group targeted for prevention strategies in nosocomial outbreaks.
authors.affiliation: Department of Infectious Diseases, Ramón y Cajal Hospital, University of Alcalá, Madrid, Spain. jcobo@hrc.insalud.es
authors.forename: J
authors.initials: J
authors.lastname: Cobo
authors.forename: A
authors.initials: A
authors.lastname: Asensio
authors.forename: S
authors.initials: S
authors.lastname: Moreno
authors.forename: E
authors.initials: E
authors.lastname: Navas
authors.forename: V
authors.initials: V
authors.lastname: Pintado
authors.forename: J
authors.initials: J
authors.lastname: Oliva
authors.forename: E
authors.initials: E
authors.lastname: Gómez-Mampaso
authors.forename: A
authors.initials: A
authors.lastname: Guerrero
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003428:Cross Infection / Q000453:epidemiology*; D004196:Disease Outbreaks; D005260:Female; D015658:HIV Infections / Q000382:microbiology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009163:Mycobacterium bovis; D016017:Odds Ratio; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology* / Q000382:microbiology / Q000821:virology