Extensively drug-resistant tuberculosis in california, 1993-2006.

Abstract

BACKGROUND:

Extensively drug-resistant (XDR) tuberculosis (TB) is a global public health emergency. We investigated the characteristics and extent of XDR TB in California to inform public health interventions.

METHODS:

XDR TB was defined as TB with resistance to at least isoniazid, rifampin, a fluoroquinolone, and 1 of 3 injectable second-line drugs (amikacin, kanamycin, or capreomycin). Pre-XDR TB was defined as TB with resistance to isoniazid and rifampin and either a fluoroquinolone or second-line injectable agent but not both. We analyzed TB case reports submitted to the state TB registry for the period 1993-2006. Local health departments and the state TB laboratory were queried to ensure complete drug susceptibility reporting.

RESULTS:

Among 424 multidrug-resistant (MDR) TB cases with complete drug susceptibility reporting, 18 (4.2%) were extensively drug resistant, and 77 (18%) were pre-extensively drug resistant. The proportion of pre-XDR TB cases increased over time, from 7% in 1993 to 32% in 2005 (P = .02)). Among XDR TB cases, 83% of cases involved foreign-born patients, and 43% were diagnosed in patients within 6 months after arrival in the United States. Mexico was the most common country of origin. Five cases (29%) of XDR TB were acquired during therapy in California. All patients with XDR TB had pulmonary disease, and most had prolonged infectious periods; the median time for conversion of sputum culture results was 195 days. Among 17 patients with known outcomes, 7 (41.2%) completed therapy, 5 (29.4%) moved, and 5 (29.4%) died. One patient continues to receive treatment.

CONCLUSIONS:

XDR TB and pre-XDR TB cases comprise a substantial fraction of MDR TB cases in California, indicating the need for interventions that improve surveillance, directly observed therapy, and rapid drug susceptibility testing and reporting.

• Authors: Ritu Banerjee, Jennifer Allen, Janice Westenhouse, Peter Oh, William Elms, Ed Desmond, Annette Nitta, Sarah Royce, Jennifer Flood
• Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (Clin Infect Dis) Vol. 47 Issue 4 Pg. 450-7 (Aug 15 2008) ISSN: 1537-6591 [Electronic] United States
• PMID: 18616396 (Publication Type: Journal Article, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Antitubercular Agents
• Culture Media

Topics

• Adolescent
• Adult
• Aged
• Antitubercular Agents (pharmacology, therapeutic use)
• California (epidemiology, ethnology)
• Child
• Child, Preschool
• Culture Media
• Disease Notification
• Emigration and Immigration
• Extensively Drug-Resistant Tuberculosis (drug therapy, epidemiology, ethnology, microbiology)
• Humans
• Infant
• Mexico
• Microbial Sensitivity Tests
• Middle Aged
• Mycobacterium tuberculosis (drug effects, isolation & purification)
• Population Surveillance
• Registries (statistics & numerical data)
• Tuberculosis, Multidrug-Resistant (epidemiology, ethnology, microbiology)
• Tuberculosis, Pulmonary (drug therapy, epidemiology, ethnology, microbiology)