RIFAMPIN-RESISTANT TUBERCULOSIS IN THE UNITED STATES, 1998–2014

Details

• Alternative Title:
  Clin Infect Dis
• Personal Author:
  Sharling, Lisa ; Marks, Suzanne M. ; Goodman, Michael ; Chorba, Terence ; Mase, Sundari
• Description:
  Background
  
  Monoresistance to rifamycins necessitates longer and more toxic regimens for tuberculosis (TB). We examined characteristics and mortality associated with rifampin-monoresistant (RMR) TB in the United States.
  
  Methods
  
  We analyzed Mycobacterium tuberculosis culture-positive cases reported to the National TB Surveillance System (excluding California because HIV infection was not reported to CDC during 2005-2010) between 1998 and 2014. We defined: (1) RMR TB found on initial drug susceptibility testing (DST), and (2) possible acquired rifampin-resistant (ARR) TB. We assessed temporal trends in RMR TB. For both classifications of rifampin resistance, we calculated adjusted risk ratios (adjRR) and 95% confidence intervals (CI) for social and clinical characteristics associated with mortality when compared to drug-susceptible TB in multivariable models using backwards selection.
  
  Results
  
  Of 180,329 TB cases, 126,431 (70%) cases were eligible for analysis, with 359 (0.28%) of eligible cases reported as RMR. The percentage of RMR TB cases with HIV declined 4% annually during 1998–2014. Persons with HIV and prior TB were more likely to have RMR TB (adjRR=25.9, CI=17.6–38.1), as were persons with HIV and no prior TB (adjRR=3.1, CI=2.4–4.1), versus those without either characteristic, controlling for other statistically significant variables. RMR cases had greater mortality (adjRR=1.4, CI=1.04–1.8), controlling for HIV and other variables. Persons with HIV had greater risk of ARR than persons without HIV (adjRR=9.6, CI=6.9–13.3) and ARR was also associated with increased mortality, controlling for HIV and other variables.
  
  Conclusions
  
  All forms of rifampin resistance were positively associated with HIV infection and increased mortality.
  
  
• Keywords:
  Antitubercular Agents Drug Resistance HIV HIV Infections Humans Isoniazid Microbial Sensitivity Tests Mycobacterium Tuberculosis Retrospective Studies Rifampin Tuberculosis Tuberculosis, Multidrug-Resistant United States

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• Source:
  Clin Infect Dis. 70(8):1596-1605
• Pubmed ID:
  31233131
• Pubmed Central ID:
  PMC6925655
• Document Type:
  Journal Article
• Funding:
  001/WHO_/World Health OrganizationInternational/ ; CC999999/ImCDC/Intramural CDC HHSUnited States/
• Volume:
  70
• Issue:
  8
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:9781d507eac7ca116dd71b77d89d13449a34de94e8a60a4283f0a5c59d5103ee
• Download URL:
  https://stacks.cdc.gov/view/cdc/83682/cdc_83682_DS1.pdf
• File Type:
  [PDF - 393.81 KB ]