Treatment of multidrug-resistant tuberculosis in San Francisco: an outpatient-based approach.
BACKGROUND
Treatment of patients with multidrug-resistant tuberculosis requires prolonged therapy, often involving long hospital stays. Despite intensive and costly therapy, cure rates are relatively low.


METHODS
We reviewed the outcomes for all patients with multidrug-resistant tuberculosis treated in San Francisco, California, during 1982-2000 and identified billing charges for patients treated during 1995-2000. Mycobacterium tuberculosis isolates were genotyped by IS6110-based restriction fragment-length polymorphism analysis.


RESULTS
Forty-eight cases were identified with resistance to a median of 3 drugs (range, 2-9 drugs). The median age of the patients was 49.5 years (range, 22-78 years); 36 (75%) of 48 patients were foreign born, 11 (23%) were human immunodeficiency virus (HIV) seropositive, and 45 (94%) had pulmonary tuberculosis. Thirty-two (97%) of the 33 HIV-seronegative patients were cured, with only 1 relapse occurring 5 years after treatment. All 11 HIV-seropositive patients died during observation. Twenty-one patients (44%) required hospitalization, with a median duration of stay of 14 days (range, 3-74 days). The estimated inpatient and outpatient aggregate cost for the 11 patients treated after 1994 was $519,928, with a median cost of $27,752 per patient. No secondary cases of multidrug-resistant tuberculosis were identified through population-based genotyping.


CONCLUSIONS
Treatment of multidrug-resistant tuberculosis in HIV-seronegative patients largely on an outpatient basis was feasible and was associated with high cure rates and lower cost than in other published studies. Patients with underlying HIV infection had very poor outcomes.
Burgos
Marcos
M
Department of Internal Medicine, Division of Infectious Diseases, University of New Mexico, Albuquerque, New Mexico 87131-5271, USA. mburgos@salud.unm.edu
Gonzalez
Leah C
LC
Paz
E Antonio
EA
Gournis
Effie
E
Kawamura
L Masae
LM
Schecter
Gisela
G
Hopewell
Philip C
PC
Daley
Charles L
CL
D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000191:economics / Q000379:methods; D000995:Antitubercular Agents / Q000191:economics / Q000627:therapeutic use*; D023801:Directly Observed Therapy; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D015658:HIV Infections / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000235:genetics; D012189:Retrospective Studies; D012495:San Francisco / Q000453:epidemiology; D014376:Tuberculosis / Q000188:drug therapy* / Q000191:economics / Q000209:etiology / Q000382:microbiology*
D000995:Antitubercular Agents