title: Treatment of multidrug-resistant tuberculosis in San Francisco: an outpatient-based approach.
abstract: 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.
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, University of New Mexico, Albuquerque, New Mexico 87131-5271, USA. mburgos@salud.unm.edu
authors.forename: Marcos
authors.initials: M
authors.lastname: Burgos
authors.forename: Leah C
authors.initials: LC
authors.lastname: Gonzalez
authors.forename: E Antonio
authors.initials: EA
authors.lastname: Paz
authors.forename: Effie
authors.initials: E
authors.lastname: Gournis
authors.forename: L Masae
authors.initials: LM
authors.lastname: Kawamura
authors.forename: Gisela
authors.initials: G
authors.lastname: Schecter
authors.forename: Philip C
authors.initials: PC
authors.lastname: Hopewell
authors.forename: Charles L
authors.initials: CL
authors.lastname: Daley
mesh_terms: 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*
chemical_list: D000995:Antitubercular Agents