A comparison of outbreak- and nonoutbreak-related multidrug-resistant tuberculosis among human immunodeficiency virus-infected patients in a South African hospital

Nosocomial multidrug-resistant tuberculosis (MDR-TB) in human immunodeficie ncy virus (HIV)-infected people is recognized in Europe and America, We rep ort the first such outbreak in South Africa. Six hospitalized women, identi fied by DNA fingerprinting, were infected with an outbreak strain of MDR-TB while receiving treatment for drug-susceptible tuberculosis. The putative source case was identified as an HIV-positive woman who underwent prolonged hospitalization for chronic cavitary tuberculosis. Compared with other HIV -positive patients in the hospital, outbreak patients were more immunocompr omised, had fewer cavitary lung changes, and were less likely to have been treated before. They had high fevers, infiltrative patterns on chest radiog raphs, and a mean survival of 43 days. When individual isolation is not pos sible, separating highly immunocompromised patients with first-time tubercu losis from previously treated patients with cavitary lesions and from those with established drug resistance may reduce nosocomial transmission.