Margaret A. Fischl, MD; Raj B. Uttamchandani, MD; George L. Daikos, MD; Rita B. Poblete, MD; Jose N. Moreno, MD; Ricardo R. Reyes, MD; Ahmad M. Boota, MD; Lisa M. Thompson, BS, BME; Timothy J. Cleary, PhD; Shenghan Lai, PhD
▪ Objective: To evaluate a nosocomial outbreak of tuberculosis caused by multiple-drug-resistant bacilli among patients with tuberculosis and HIV infection.
▪ Design: A case-control study.
▪ Patients: Patients with HIV infection and culture-proven tuberculosis.
▪ Measurements: Patient characteristics, date of diagnoses of HIV infection and disease, date of diagnosis of tuberculosis, Mycobacterium tuberculosis susceptibility results, and medical center contact.
▪ Results: Sixty-two patients who had tuberculosis caused by multiple-drug-resistant bacilli (cases) and 55 patients who had tuberculosis caused by susceptible or single-drug-resistant bacilli (controls) were identified. Controls were more likely to be black (odds ratio, 0.4; 95% Cl, 0.2 to 0.9) or Haitian (odds ratio, 0.2; Cl, 0.1 to 0.6) compared with cases, who were more likely to be homosexual men (odds ratio, 2.9; Cl, 1.3 to 6.4). Forty-four cases (71%) had previous contact with an HIV clinic compared with 15 controls (27%) (P < 0.0001). Cases were more likely to have had AIDS (odds ratio, 7.7; Cl, 1.5 to 53.7), to have been hospitalized on an HIV ward (odds ratio, 8.3; Cl, 2.3 to 29.7), to have been seen in an HIV clinic (odds ratio, 7.8; Cl, 3.4 to 18.1), to have received intravenous therapy in an HIV clinic (odds ratio, 13.0; Cl, 4.6 to 37.0), or to have received inhalation pentamidine in an HIV clinic before a diagnosis of tuberculosis was made. Multiple logistic regression analysis showed that a diagnosis of AIDS (odds ratio, 11.2; Cl, 3.1 to 40.6) and HIV clinic visits (odds ratio, 13.0; Cl, 2.7 to 63.7) before a diagnosis of tuberculosis were significantly associated with tuberculosis caused by multiple-drug-resistant bacilli. Using susceptibility patterns and appointment dates, we found that 22 cases had previous contact with a person who had tuberculosis caused by multiple-drug-resistant bacilli in the HIV clinic.
▪ Conclusions: Nosocomial transmission of M. tuberculosis from other HIV-infected patients with tuberculosis caused by multiple-drug-resistant bacilli can occur. These findings have serious public health implications and demand strict adherence to acid-fast bacilli isolation precautions.
Margaret A. Fischl, Raj B. Uttamchandani, George L. Daikos, Rita B. Poblete, Jose N. Moreno, Ricardo R. Reyes, et al. An Outbreak of Tuberculosis Caused by Multiple-Drug-resistant Tubercle Bacilli among Patients with HIV Infection. Ann Intern Med. 1992;117:177–183. doi: 10.7326/0003-4819-117-3-177
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Published: Ann Intern Med. 1992;117(3):177-183.
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