Affiliation:
1. Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine
2. Division of Tuberculosis Elimination, Centers for Disease Control and Prevention
3. Department of Health and Human Services, Emory University Rollins School of Public Health, Atlanta, Georgia
4. World Health Organization, Tuberculosis Department, Country Office for India, New Delhi
Abstract
Abstract
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) between 1998 and 2014. We defined RMR TB found on initial drug susceptibility testing and possible acquired rifampin-resistant (ARR) TB. We assessed temporal trends in RMR TB. For both classifications of rifampin resistance, we calculated adjusted risk ratios (adjRRs) and 95% confidence intervals (CIs) for characteristics associated with mortality when compared with drug-susceptible TB in multivariable models using backward selection.
Results
Of 180 329 TB cases, 126 431 (70%) 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 between 1998 and 2014. Persons with HIV and prior TB were more likely to have RMR TB (adjRR, 25.9; 95% CI, 17.6–38.1), as were persons with HIV and no prior TB (adjRR, 3.1; 95% CI, 2.4–4.1) vs those without either characteristic, controlling for other statistically significant variables. RMR cases had greater mortality (adjRR, 1.4; 95% 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; 95% 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.
Funder
National Center for Environmental Health
Division of Laboratory Sciences
Oak Ridge Institute for Science and Education
Tuberculosis Epidemiologic Studies Consortium of CDC
Publisher
Oxford University Press (OUP)
Subject
Infectious Diseases,Microbiology (medical)
Reference39 articles.
1. Experimental models to explain the high sterilizing activity of rifampin in the chemotherapy of tuberculosis;Dickinson;Am Rev Respir Dis,1981
2. American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis;Blumberg;Am J Respir Crit Care Med,2003
3. Influence of initial drug resistance on the response to short-course chemotherapy of pulmonary tuberculosis;Mitchison;Am Rev Respir Dis,1986
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