Epidemiology of pyrazinamide-resistant tuberculosis in the United States, 1999-2009

Details

• Alternative Title:
  Clin Infect Dis
• Personal Author:
  Kurbatova, Ekaterina V. ; Cavanaugh, Joseph S. ; Dalton, Tracy ; Click, Eleanor ; Cegielski, J. Peter
• Description:
  Introduction ; Pyrazinamide (PZA) is essential in tuberculosis (TB) treatment. We describe the prevalence, trends and predictors of PZA resistance in Mycobacterium tuberculosis complex (MTBC) in the U.S. ; Methods ; We analyzed culture-positive MTBC cases with reported drug susceptibility tests (DST) for PZA in 38 jurisdictions routinely testing for PZA susceptibility from 1999-2009. National TB Genotyping Service data for 2004-2009 were used to distinguish Mycobacterium tuberculosis from Mycobacterium bovis and determine phylogenetic lineage. ; Results ; Overall 2.7% (2,167/79,321) of MTBC cases had PZA resistance, increasing annually from 2.0% to 3.3% during 1999-2009 (P<0.001), largely due to an increase in PZA monoresistance. PZA-monoresistant MTBC (versus drug-susceptible) was associated with age 0-24 years (adjusted prevalence ratio aPR=1.50, 95% CI 1.31-1.71), Hispanic ethnicity (aPR=3.52, 2.96-4.18), HIV infection (aPR=1.43, 1.15-1.77), extrapulmonary disease (aPR=3.02, 2.60-3.52), and normal chest radiograph (aPR=1.88, 1.63-2.16), and inversely associated with Asian (aPR=0.59, 0.47-0.73) and Black (aPR=0.37, 0.29-0.49) race. Among multidrug-resistant (MDR) cases 38.0% were PZA-resistant; PZA resistance in MDR MTBC was associated with female sex (aPR=1.25, 1.08-1.46) and previous TB diagnosis (aPR=1.37, 1.16-1.62). Of 28,080 cases with genotyping data, 925 (3.3%) had PZA resistance; 465/925 (50.3%) were M. bovis. In non-MDR M. tuberculosis cases, PZA resistance was higher in the Indo-Oceanic than the East Asian lineage (2.2% versus 0.9%; respectively; aPR=2.26, 1.53-3.36), but in MDR cases it was lower in the Indo-Oceanic lineage (22.0% versus 43.4%, respectively; aPR=0.54, 0.32-0.90). ; Conclusions ; Specific human and mycobacterial characteristics were associated with pyrazinamide-resistant MTBC, reflecting both specific subgroups of the population and phylogenetic lineages of the mycobacteria.
• Subjects:
  • Adolescent
  • Adult
  • Aged
  • Antitubercular Agents
  • Child
  • Child, Preschool
  • Drug Resistance, Bacterial
  • Female
  • Humans
  • Infant
  More +
• Keywords:
  • tuberculosis
  • drug resistance
  • epidemiology
  • pyrazinamide
• Source:
  Clin Infect Dis. 57(8):1081-1093
• Pubmed ID:
  23840002
• Pubmed Central ID:
  PMC4578633
• Document Type:
  Journal Article
• Funding:
  CC999999/Intramural CDC HHSUnited States/
• Volume:
  57
• Issue:
  8
• Download URL:
  https://stacks.cdc.gov/view/cdc/34431/cdc_34431_DS1.pdf
• File Type:
  [PDF - 971.83 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:cf3da5faeaa968eebae4c0d30260ca15f89e66b3515847f828c5ce7ac569efd7