Extensively Drug-Resistant Tuberculosis in California, 1993–2006
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 fluor...
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| Veröffentlicht in: | Clinical infectious diseases 2008-08, Vol.47 (4), p.450-457 |
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| creator | Banerjee, Ritu Allen, Jennifer Westenhouse, Janice Oh, Peter Elms, William Desmond, Ed Nitta, Annette Royce, Sarah Flood, Jennifer |
| description | 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. |
| doi_str_mv | 10.1086/590009 |
| format | Article |
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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.</description><identifier>ISSN: 1058-4838</identifier><identifier>EISSN: 1537-6591</identifier><identifier>DOI: 10.1086/590009</identifier><identifier>PMID: 18616396</identifier><identifier>CODEN: CIDIEL</identifier><language>eng</language><publisher>Chicago, IL: The University of Chicago Press</publisher><subject>Adolescent ; Adult ; Aged ; Antibiotics ; Antitubercular Agents - pharmacology ; Antitubercular Agents - therapeutic use ; Antituberculars ; Articles and Commentaries ; Bacterial diseases ; Biological and medical sciences ; California - epidemiology ; California - ethnology ; Cardiology ; Child ; Child, Preschool ; Culture Media ; Disease Notification ; Disease resistance ; Drug resistance ; Emigration and Immigration ; Extensively Drug-Resistant Tuberculosis - drug therapy ; Extensively Drug-Resistant Tuberculosis - epidemiology ; Extensively Drug-Resistant Tuberculosis - ethnology ; Extensively Drug-Resistant Tuberculosis - microbiology ; Fluoroquinolones ; Health outcomes ; Human bacterial diseases ; Humans ; Infant ; Infectious diseases ; Medical sciences ; Mexico ; Microbial Sensitivity Tests ; Middle Aged ; Multidrug resistant tuberculosis ; Mycobacterium ; Mycobacterium tuberculosis ; Mycobacterium tuberculosis - drug effects ; Mycobacterium tuberculosis - isolation & purification ; Pathology ; Population Surveillance ; Preventive medicine ; Public health ; Pulmonary tuberculosis ; Registries - statistics & numerical data ; Tuberculosis ; Tuberculosis and atypical mycobacterial infections ; Tuberculosis, Multidrug-Resistant - epidemiology ; Tuberculosis, Multidrug-Resistant - ethnology ; Tuberculosis, Multidrug-Resistant - microbiology ; Tuberculosis, Pulmonary - drug therapy ; Tuberculosis, Pulmonary - epidemiology ; Tuberculosis, Pulmonary - ethnology ; Tuberculosis, Pulmonary - microbiology</subject><ispartof>Clinical infectious diseases, 2008-08, Vol.47 (4), p.450-457</ispartof><rights>Copyright 2008 Infectious Diseases Society of America</rights><rights>2008 by the Infectious Diseases Society of America 2008</rights><rights>2008 INIST-CNRS</rights><rights>Copyright University of Chicago, acting through its Press Aug 15, 2008</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c483t-d375980c1341f25fe80f2823c09c4a4e2846e03a07a2fe0fbb0d7626db9fe1233</citedby><cites>FETCH-LOGICAL-c483t-d375980c1341f25fe80f2823c09c4a4e2846e03a07a2fe0fbb0d7626db9fe1233</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.jstor.org/stable/pdf/40307780$$EPDF$$P50$$Gjstor$$H</linktopdf><linktohtml>$$Uhttps://www.jstor.org/stable/40307780$$EHTML$$P50$$Gjstor$$H</linktohtml><link.rule.ids>314,780,784,803,27924,27925,58017,58250</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=20558218$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18616396$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Banerjee, Ritu</creatorcontrib><creatorcontrib>Allen, Jennifer</creatorcontrib><creatorcontrib>Westenhouse, Janice</creatorcontrib><creatorcontrib>Oh, Peter</creatorcontrib><creatorcontrib>Elms, William</creatorcontrib><creatorcontrib>Desmond, Ed</creatorcontrib><creatorcontrib>Nitta, Annette</creatorcontrib><creatorcontrib>Royce, Sarah</creatorcontrib><creatorcontrib>Flood, Jennifer</creatorcontrib><title>Extensively Drug-Resistant Tuberculosis in California, 1993–2006</title><title>Clinical infectious diseases</title><addtitle>Clinical Infectious Diseases</addtitle><addtitle>Clinical Infectious Diseases</addtitle><description>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.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Antibiotics</subject><subject>Antitubercular Agents - pharmacology</subject><subject>Antitubercular Agents - therapeutic use</subject><subject>Antituberculars</subject><subject>Articles and Commentaries</subject><subject>Bacterial diseases</subject><subject>Biological and medical sciences</subject><subject>California - epidemiology</subject><subject>California - ethnology</subject><subject>Cardiology</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Culture Media</subject><subject>Disease Notification</subject><subject>Disease resistance</subject><subject>Drug resistance</subject><subject>Emigration and Immigration</subject><subject>Extensively Drug-Resistant Tuberculosis - drug therapy</subject><subject>Extensively Drug-Resistant Tuberculosis - epidemiology</subject><subject>Extensively Drug-Resistant Tuberculosis - ethnology</subject><subject>Extensively Drug-Resistant Tuberculosis - microbiology</subject><subject>Fluoroquinolones</subject><subject>Health outcomes</subject><subject>Human bacterial diseases</subject><subject>Humans</subject><subject>Infant</subject><subject>Infectious diseases</subject><subject>Medical sciences</subject><subject>Mexico</subject><subject>Microbial Sensitivity Tests</subject><subject>Middle Aged</subject><subject>Multidrug resistant tuberculosis</subject><subject>Mycobacterium</subject><subject>Mycobacterium tuberculosis</subject><subject>Mycobacterium tuberculosis - drug effects</subject><subject>Mycobacterium tuberculosis - isolation & purification</subject><subject>Pathology</subject><subject>Population Surveillance</subject><subject>Preventive medicine</subject><subject>Public health</subject><subject>Pulmonary tuberculosis</subject><subject>Registries - statistics & numerical data</subject><subject>Tuberculosis</subject><subject>Tuberculosis and atypical mycobacterial infections</subject><subject>Tuberculosis, Multidrug-Resistant - epidemiology</subject><subject>Tuberculosis, Multidrug-Resistant - ethnology</subject><subject>Tuberculosis, Multidrug-Resistant - microbiology</subject><subject>Tuberculosis, Pulmonary - drug therapy</subject><subject>Tuberculosis, Pulmonary - epidemiology</subject><subject>Tuberculosis, Pulmonary - ethnology</subject><subject>Tuberculosis, Pulmonary - microbiology</subject><issn>1058-4838</issn><issn>1537-6591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqF0dtqFDEYAOAgSs--gTIt1CtH_5yTy7qt9gRqqSjehEw2kdnOzqzJTGnv-g6-oU9iyixbKEivEvJ__PkPCL3E8A6DEu-5BgD9DG1gTmUpuMbP8x24Kpmiah1tpjQDwFgBX0PrWAksqBYb6MPRTe_bVF_75rY4jMOv8sKnOvW27YvLofLRDU2XH4q6LSa2qUMX29q-LbDW9O_dHwIgttGLYJvkd5bnFvr28ehyclyef_50Mjk4L10uoS-nVHKtwGHKcCA8eAWBKEIdaMcs80Qx4YFakJYED6GqYCoFEdNKB48JpVvozZh3Ebvfg0-9mdfJ-aaxre-GZISmhGEtn4QEM0oFxxnuPYKzbohtbiIbrQUQCQ_ZXOxSij6YRaznNt4aDOZ-9macfYavl9mGau6nD2w57Az2l8AmZ5sQbevqtHIEOFcEq-x2R9cNi_9_9mo0s9R3caUYUJBS3VddjvG8S3-zitt4ZYTMmzDHP36a0-8Xp2dnX78YRv8BPTWrFg</recordid><startdate>20080815</startdate><enddate>20080815</enddate><creator>Banerjee, Ritu</creator><creator>Allen, Jennifer</creator><creator>Westenhouse, Janice</creator><creator>Oh, Peter</creator><creator>Elms, William</creator><creator>Desmond, Ed</creator><creator>Nitta, Annette</creator><creator>Royce, Sarah</creator><creator>Flood, Jennifer</creator><general>The University of Chicago Press</general><general>University of Chicago Press</general><general>Oxford University Press</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7T2</scope><scope>7T7</scope><scope>7U7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>20080815</creationdate><title>Extensively Drug-Resistant Tuberculosis in California, 1993–2006</title><author>Banerjee, Ritu ; Allen, Jennifer ; Westenhouse, Janice ; Oh, Peter ; Elms, William ; Desmond, Ed ; Nitta, Annette ; Royce, Sarah ; Flood, Jennifer</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c483t-d375980c1341f25fe80f2823c09c4a4e2846e03a07a2fe0fbb0d7626db9fe1233</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Antibiotics</topic><topic>Antitubercular Agents - pharmacology</topic><topic>Antitubercular Agents - therapeutic use</topic><topic>Antituberculars</topic><topic>Articles and Commentaries</topic><topic>Bacterial diseases</topic><topic>Biological and medical sciences</topic><topic>California - epidemiology</topic><topic>California - ethnology</topic><topic>Cardiology</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Culture Media</topic><topic>Disease Notification</topic><topic>Disease resistance</topic><topic>Drug resistance</topic><topic>Emigration and Immigration</topic><topic>Extensively Drug-Resistant Tuberculosis - drug therapy</topic><topic>Extensively Drug-Resistant Tuberculosis - epidemiology</topic><topic>Extensively Drug-Resistant Tuberculosis - ethnology</topic><topic>Extensively Drug-Resistant Tuberculosis - microbiology</topic><topic>Fluoroquinolones</topic><topic>Health outcomes</topic><topic>Human bacterial diseases</topic><topic>Humans</topic><topic>Infant</topic><topic>Infectious diseases</topic><topic>Medical sciences</topic><topic>Mexico</topic><topic>Microbial Sensitivity Tests</topic><topic>Middle Aged</topic><topic>Multidrug resistant tuberculosis</topic><topic>Mycobacterium</topic><topic>Mycobacterium tuberculosis</topic><topic>Mycobacterium tuberculosis - drug effects</topic><topic>Mycobacterium tuberculosis - isolation & purification</topic><topic>Pathology</topic><topic>Population Surveillance</topic><topic>Preventive medicine</topic><topic>Public health</topic><topic>Pulmonary tuberculosis</topic><topic>Registries - statistics & numerical data</topic><topic>Tuberculosis</topic><topic>Tuberculosis and atypical mycobacterial infections</topic><topic>Tuberculosis, Multidrug-Resistant - epidemiology</topic><topic>Tuberculosis, Multidrug-Resistant - ethnology</topic><topic>Tuberculosis, Multidrug-Resistant - microbiology</topic><topic>Tuberculosis, Pulmonary - drug therapy</topic><topic>Tuberculosis, Pulmonary - epidemiology</topic><topic>Tuberculosis, Pulmonary - ethnology</topic><topic>Tuberculosis, Pulmonary - microbiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Banerjee, Ritu</creatorcontrib><creatorcontrib>Allen, Jennifer</creatorcontrib><creatorcontrib>Westenhouse, Janice</creatorcontrib><creatorcontrib>Oh, Peter</creatorcontrib><creatorcontrib>Elms, William</creatorcontrib><creatorcontrib>Desmond, Ed</creatorcontrib><creatorcontrib>Nitta, Annette</creatorcontrib><creatorcontrib>Royce, Sarah</creatorcontrib><creatorcontrib>Flood, Jennifer</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Banerjee, Ritu</au><au>Allen, Jennifer</au><au>Westenhouse, Janice</au><au>Oh, Peter</au><au>Elms, William</au><au>Desmond, Ed</au><au>Nitta, Annette</au><au>Royce, Sarah</au><au>Flood, Jennifer</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Extensively Drug-Resistant Tuberculosis in California, 1993–2006</atitle><jtitle>Clinical infectious diseases</jtitle><stitle>Clinical Infectious Diseases</stitle><addtitle>Clinical Infectious Diseases</addtitle><date>2008-08-15</date><risdate>2008</risdate><volume>47</volume><issue>4</issue><spage>450</spage><epage>457</epage><pages>450-457</pages><issn>1058-4838</issn><eissn>1537-6591</eissn><coden>CIDIEL</coden><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.</abstract><cop>Chicago, IL</cop><pub>The University of Chicago Press</pub><pmid>18616396</pmid><doi>10.1086/590009</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Clinical infectious diseases, 2008-08, Vol.47 (4), p.450-457 |
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| source | MEDLINE; JSTOR Archive Collection A-Z Listing; Oxford University Press Journals All Titles (1996-Current); EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Adolescent Adult Aged Antibiotics Antitubercular Agents - pharmacology Antitubercular Agents - therapeutic use Antituberculars Articles and Commentaries Bacterial diseases Biological and medical sciences California - epidemiology California - ethnology Cardiology Child Child, Preschool Culture Media Disease Notification Disease resistance Drug resistance Emigration and Immigration Extensively Drug-Resistant Tuberculosis - drug therapy Extensively Drug-Resistant Tuberculosis - epidemiology Extensively Drug-Resistant Tuberculosis - ethnology Extensively Drug-Resistant Tuberculosis - microbiology Fluoroquinolones Health outcomes Human bacterial diseases Humans Infant Infectious diseases Medical sciences Mexico Microbial Sensitivity Tests Middle Aged Multidrug resistant tuberculosis Mycobacterium Mycobacterium tuberculosis Mycobacterium tuberculosis - drug effects Mycobacterium tuberculosis - isolation & purification Pathology Population Surveillance Preventive medicine Public health Pulmonary tuberculosis Registries - statistics & numerical data Tuberculosis Tuberculosis and atypical mycobacterial infections Tuberculosis, Multidrug-Resistant - epidemiology Tuberculosis, Multidrug-Resistant - ethnology Tuberculosis, Multidrug-Resistant - microbiology Tuberculosis, Pulmonary - drug therapy Tuberculosis, Pulmonary - epidemiology Tuberculosis, Pulmonary - ethnology Tuberculosis, Pulmonary - microbiology |
| title | Extensively Drug-Resistant Tuberculosis in California, 1993–2006 |
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