This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (269)  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Alan B. Bloch, MD, MPH; George M. Cauthen, ScD; Ida M. Onorato, MD; Kenneth G. Dansbury; Gloria D. Kelly; Cynthia R. Driver, MPH; Dixie E. Snider, Jr, MD, MPH

JAMA. 1994;271(9):665-671.

Abstract
Objective.
—To determine antituberculosis drug resistance patterns, geographic distribution, demographic characteristics, and risk factors of reported tuberculosis (TB) patients in the United States.

Design.
—Survey of reported TB cases in the United States. For culture-positive cases reported to the Centers for Disease Control and Prevention, we asked health departments to provide drug susceptibility test results from initial Mycobacterium tuberculosis isolates.

Study Population.
—Culture-positive TB cases in the United States reported during the first quarter of 1991.

Main Outcome Measures.
—Individual TB case reports submitted to the Centers for Disease Control and Prevention and drug susceptibility test results.

Results.
—Resistance to one or more antituberculosis drugs was found in 14.2% of cases. Resistance to isoniazid and/or rifampin was found in 9.5% of cases whose isolates were tested against one or both drugs; such cases were found in 107 counties in 33 states. Resistance to both isoniazid and rifampin (multidrug-resistant [MDR] TB) was found in 3.5% of cases whose isolates were tested against both drugs; such cases were found in 35 counties in 13 states. New York City accounted for 61.4% of the nation's MDR TB cases. The 3-month population-based incidence rate of MDR TB in New York City was 52.4 times (95% confidence interval [CI], 35.5 to 78.3) that of the rest of the nation (9.559 vs 0.182 cases per million population). Compared with the rate in non-Hispanic whites in the rest of the nation (0.032 cases per million), the relative risk of MDR TB in New York City non-Hispanic whites was 39.0 (95% CI, 8.1 to 164.5), 299.3 (95% CI, 112.5 to 927.1) in Hispanics, 420.9 (95% CI, 121.0 to 1515.8) in Asian/Pacific Islanders, and 701.0 (95% CI, 296.4 to 2018.1) in non-Hispanic blacks.

Conclusions.
—With nearly 10% of TB patients resistant to isoniazid and/or rifampin, greater use of four-drug regimens and directly observed therapy is indicated. Aggressive intervention to prevent the further spread of MDR TB is needed to find every TB patient and to provide optimal patient management to ensure completion of chemotherapy.

(JAMA. 1994;271:665-671)

Author Affiliations
From the Division of Tuberculosis Elimination, National Center for Prevention Services, Centers for Disease Control and Prevention, Atlanta, Ga.

Footnotes
Reprint requests to Information Services Office, National Center for Prevention Services, Centers for Disease Control and Prevention, 1600 Clifton Rd, Mailstop E-08, Atlanta, GA 30333 (Dr Bloch).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Surveillance of Antituberculosis Drug Resistance Among Children From the Western Cape Province of South Africa--An Upward Trend
Schaaf et al.
AJPH 2009;99:1486-1490.
ABSTRACT | FULL TEXT  

Susceptibility Pattern and Epidemiology of Mycobacterium tuberculosis in a Saudi Arabian Hospital: A 15-Year Study From 1989 to 2003
Al-Tawfiq et al.
Chest 2005;128:3229-3232.
ABSTRACT | FULL TEXT  

Multidrug Resistance Among Persons With Tuberculosis in California, 1994-2003
Granich et al.
JAMA 2005;293:2732-2739.
ABSTRACT | FULL TEXT  

Incidence of Tuberculosis in Olmsted County, Minnesota, 1990-2001
Jump et al.
Mayo Clin Proc. 2004;79:1119-1123.
ABSTRACT  

Resazurin Microtiter Assay Plate Testing of Mycobacterium tuberculosis Susceptibilities to Second-Line Drugs: Rapid, Simple, and Inexpensive Method
Martin et al.
Antimicrob. Agents Chemother. 2003;47:3616-3619.
ABSTRACT | FULL TEXT  

Activity of a new class of isonicotinoylhydrazones used alone and in combination with isoniazid, rifampicin, ethambutol, para-aminosalicylic acid and clofazimine against Mycobacterium tuberculosis
De Logu et al.
J Antimicrob Chemother 2002;49:275-282.
ABSTRACT | FULL TEXT  

Action Mechanism of Antitubercular Isoniazid. ACTIVATION BY MYCOBACTERIUM TUBERCULOSIS KatG, ISOLATION, AND CHARACTERIZATION OF InhA INHIBITOR
Lei et al.
J. Biol. Chem. 2000;275:2520-2526.
ABSTRACT | FULL TEXT  

Predictors of Sputum Culture Conversion Among Patients With Tuberculosis in the Era of Tuberculosis Resurgence
Liu et al.
Arch Intern Med 1999;159:1110-1116.
ABSTRACT | FULL TEXT  

Molecular Evidence for Heterogeneity of the Multiple-Drug-Resistant Mycobacterium tuberculosis Population in Scotland (1990 to 1997)
Fang et al.
J. Clin. Microbiol. 1999;37:998-1003.
ABSTRACT | FULL TEXT  

Safe Determination of Susceptibility of Mycobacterium tuberculosis to Antimycobacterial Agents by Flow Cytometry
Moore et al.
J. Clin. Microbiol. 1999;37:479-483.
ABSTRACT | FULL TEXT  

Flow Cytometric Testing of Susceptibilities of Mycobacterium tuberculosis Isolates to Ethambutol, Isoniazid, and Rifampin in 24 Hours
Kirk et al.
J. Clin. Microbiol. 1998;36:1568-1573.
ABSTRACT | FULL TEXT  

Risk Factors for Rifampin Mono-resistant Tuberculosis
RIDZON et al.
Am. J. Respir. Crit. Care Med. 1998;157:1881-1884.
ABSTRACT | FULL TEXT  

Identification of a New DNA Region Specific for Members of Mycobacterium tuberculosis Complex
Magdalena et al.
J. Clin. Microbiol. 1998;36:937-943.
ABSTRACT | FULL TEXT  

Directly Observed Therapy for Treatment Completion of Pulmonary Tuberculosis: Consensus Statement of the Public Health Tuberculosis Guidelines Panel
Chaulk et al.
JAMA 1998;279:943-948.
ABSTRACT | FULL TEXT  

Current Concepts in the Pharmacologic Treatment and Management of Tuberculosis
Gravatt
The Journal of School Nursing 1997;13:28-38.
ABSTRACT  

Trends in Drug-Resistant Tuberculosis in the United States, 1993-1996
Moore et al.
JAMA 1997;278:833-837.
ABSTRACT  

Defending the Public's Health Against Tuberculosis
Public Health Is Purchasable. Within Natural Limit and Reichman
JAMA 1997;278:865-867.
ABSTRACT  

The Cost-effectiveness of Preventing Tuberculosis in Physicians Using Tuberculin Skin Testing or a Hypothetical Vaccine
Nettleman et al.
Arch Intern Med 1997;157:1121-1127.
ABSTRACT  

A Continuing Survey of Drug-Resistant Tuberculosis, New York City, April 1994
Fujiwara et al.
Arch Intern Med 1997;157:531-536.
ABSTRACT  

Misdiagnosis of Multidrug-Resistant Tuberculosis Possibly Due to Laboratory-Related Errors
Nitta et al.
JAMA 1996;276:1980-1983.
ABSTRACT  

Evaluation of Tuberculosis Control Policies Using Computer Simulation
Brewer et al.
JAMA 1996;276:1898-1903.
ABSTRACT  

The Relationship Between Delayed or Incomplete Treatment and All-Cause Mortality in Patients With Tuberculosis
Pablos-Mendez et al.
JAMA 1996;276:1223-1228.
ABSTRACT  

A Multi-institutional Outbreak of Highly Drug-Resistant Tuberculosis: Epidemiology and Clinical Outcomes
Frieden et al.
JAMA 1996;276:1229-1235.
ABSTRACT  

Are healthcare workers in England and Wales at increased risk of tuberculosis?
Meredith et al.
BMJ 1996;313:522-525.
ABSTRACT | FULL TEXT  

Preventive Therapy for Multidrug-Resistant Tuberculosis-Reply
Villarino et al.
JAMA 1996;276:28-28.
ABSTRACT  

Rifampin-Resistant Tuberculosis in a Patient Receiving Rifabutin Prophylaxis
Bishai et al.
NEJM 1996;334:1573-1576.
FULL TEXT  

Biosynthesis of the Linkage Region of the Mycobacterial Cell Wall
Mikusová et al.
J. Biol. Chem. 1996;271:7820-7828.
ABSTRACT | FULL TEXT  

Origin and Interstate Spread of a New York City Multidrug-Resistant Mycobacterium tuberculosis Clone Family
Bifani et al.
JAMA 1996;275:452-457.
ABSTRACT  

Preventing Multidrug-Resistant Tuberculosis
Bloch et al.
JAMA 1996;275:487-489.
ABSTRACT  

Multidrug-Resistant Tuberculosis in Patients without HIV Infection
Telzak et al.
NEJM 1995;333:907-912.
ABSTRACT | FULL TEXT  

Health-Care Expenditures for Tuberculosis in the United States
Brown et al.
Arch Intern Med 1995;155:1595-1600.
ABSTRACT  

Isoniazid Preventive Therapy in Areas of High Isoniazid Resistance
Sterling et al.
Arch Intern Med 1995;155:1622-1628.
ABSTRACT  

Tuberculosis in New York City -- Turning the Tide
Frieden et al.
NEJM 1995;333:229-233.
ABSTRACT | FULL TEXT  

Immigrants and Tuberculosis Control
Iseman and Starke
NEJM 1995;332:1094-1095.
FULL TEXT  

Multiple-Antibiotic-Resistant Bacteria
Bloch et al.
NEJM 1994;331:678-679.
FULL TEXT  

Expanded Tuberculosis Surveillance and Tuberculosis Morbidity--United States, 1993
JAMA 1994;272:265-266.
 

Tracking Tuberculosis
Bloch et al.
JAMA 1994;272:200-201.
ABSTRACT  

Drug-Resistant Tuberculosis in the U.S.
Journal Watch Dermatology 1994;1994:14-14.
FULL TEXT  

DRUG-RESISTANT TUBERCULOSIS IN THE U.S
JWatch General 1994;1994:1-1.
FULL TEXT  

Failure of Tuberculosis Control: A Prescription for Change
Bellin
JAMA 1994;271:708-709.
ABSTRACT