NATIONWIDE SURVEY OF DRUG-RESISTANT TUBERCULOSIS IN THE UNITED-STATES

Objective.-To determine antituberculosis drug resistance patterns, geo graphic distribution, demographic characteristics, and risk factors of reported tuberculosis (TB) patients in the United States. Design.-Sur vey of reported TB cases in the United States. For culture-positive ca ses reported to the Centers for Disease Control and Prevention, we ask ed health departments to provide drug susceptibility test results from initial Mycobacterium tuberculosis isolates. Study Population.-Cultur e-positive TB cases in the United States reported during the first qua rter of 1991. Main Outcome Measures.-Individual TB case reports submit ted to the Centers for Disease Control and Prevention and drug suscept ibility test results. Result.-Resistance to one or more antituberculos is drugs was found in 14.2% of cases. Resistance to isoniazid and/or r ifampin 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 Ci ty accounted for 61.4% of the nation's MDR TB cases. The 3-month popul ation-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 na tion (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 w hites 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 islande rs, and 701.0 (95% CI, 296.4 to 2018.1) in non-Hispanic blacks. Conclu sions.-With nearly 10% of TB patients resistant to isoniazid and/or ri fampin, greater use of four-drug regimens and directly observed therap y is indicated. Aggressive intervention to prevent the further spread of MDR TB is needed to find every TB patient and to provide optimal pa tient, management to ensure completion of chemotherapy.