Risk factors for rifampin-monoresistant tuberculosis - A case-control study

Rifampin is the cornerstone of short-course chemotherapy for the treatment of tuberculosis (TB). Rifampin monoresistance (RMR) is less common than res istance to isoniazid alone or in combination with other antituberculous med ications. We conducted a retrospective case-control study to identify risk factors for RMR-TB. Complete records for 21 of a total of 26 RMR patients f rom 1990 to 1997 were available for review, and were compared with those of 48 patients with drug-susceptible TB, controlling for year of diagnosis. C ases more frequently had a history of TB than did controls (61% versus 22%, p < 0.01), and were more often human immunodeficiency virus (HIV) positive (81% versus 46%, p = 0.02). With control for HIV status, cases were more l ikely to have extrapulmonary involvement (47.6% versus 11.6%, p = 0.05). Fo ur cases (19%) and one control (2.1%) died (p = 0.02) during hospitalizatio n. Cases more often had a history of incarceration (71.4% versus 37.5%, p = 0.09). Among the 13 cases with a history of TB, five had evidence of malab sorption (vomiting and/or diarrhea), versus none of the 11 controls with pr ior TB. These data support the hypothesis that RMR is seen primarily in ind ividuals with a history of TB and who are HIV positive. Cases were frequent ly noncompliant with previous treatment for TB, had a history of incarcerat ion, and had poor outcomes.