March 10, 1997

A Continuing Survey of Drug-Resistant Tuberculosis, New York City, April 1994

Author Affiliations

From the New York City Department of Health, New York, NY (Drs Fujiwara, Osahan, Ebrahimzadeh, and Frieden and Mss Cook and Rutherford and Mr Sachdev); the Divisions of Tuberculosis Elimination, National Center for HIV, STD, and TB Prevention (Drs Fujiwara and Frieden) and AIDS, STD, and TB Laboratory Research (Dr Crawford and Ms Glickman), National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga; and the Public Health Research Institute, New York, NY (Dr Kreiswirth).

Arch Intern Med. 1997;157(5):531-536. doi:10.1001/archinte.1997.00440260077012

Background:  A 1991 survey showed high levels of drug resistance among tuberculosis patients in New York, NY. As a result, the tuberculosis control program was strengthened, including expanded use of directly observed therapy and improved infection control.

Methods:  We collected isolates from every patient in New York City with a positive culture for Mycobacterium tuberculosis during April 1994; results were compared with those in the April 1991 survey.

Results:  From 1991 to 1994, the number of patients decreased from 466 to 332 patients. The percentage with isolates resistant to 1 or more antituberculosis drugs decreased from 33% to 24% (P<.01); with isolates resistant to at least isoniazid decreased from 26% to 18% (P<.05); and with isolates resistant to both isoniazid and rifampin decreased from 19% to 13% (P<.05). The number of patients with isolates resistant to both isoniazid and rifampin decreased by more than 50%. Among never previously treated patients, the percentage with resistance to 1 or more drugs decreased from 22% in 1991 to 13% in 1994 (P<.05). The number of patients with consistently positive culture results for more than 4 months decreased from 130 to 44. A history of antituberculosis treatment was the strongest predictor of drug resistance (odds ratio=3.1; P<.001). Human immunodeficiency virus infection was associated with drug resistance among patients who never had been treated for tuberculosis.

Conclusions:  Drug-resistant tuberculosis declined significantly in New York City from 1991 to 1994. Measures to control and prevent tuberculosis were associated with a 29% decrease in the proportion of drug resistance and a 52% decrease in the number of patients with multidrug-resistant tuberculosis.Arch Intern Med. 1997;157:531-536