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Free Content A city-wide outbreak of a multiple-drug-resistant strain of Mycobacterium tuberculosis in New York

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Setting: Incident patients with active tuberculosis (TB) resistant to two or more drugs in New York City hospitals in 1992.

Objective: To examine the New York-wide distribution of Public Health Research Institute (PHRI) strain W of Mycobacterium tuberculosis, an extremely drug-resistant strain identified by a 17-band Southern hybridization pattern using IS6110, during the peak tuberculosis year of 1992. We also compared strain W with other strains frequently observed in New York.

Design: Blinded retrospective study of stored M. tuberculosis cultures by restriction fragment length polymorphism (RFLP) DNA fingerprinting, and chart review.

Results: We found 112 cultures with the strain W fingerprint and 8 variants in 21 hospitals among incident patients hospitalized in 1992. Almost all isolates were resistant to four first-line drugs and kanamycin. This single strain made up at least 22% of New York City multiple-drug-resistant (MDR) TB in 1992, far more than any other strain. Almost all W-strain cases were acquired immune deficiency syndrome (AIDS) patients. The cluster is the most drug-resistant cluster identified in New York and the largest IS6110 fingerprint cluster identified anywhere to date.

Conclusion: Because recommended four-drug therapy will not sterilise this very resistant strain, there was a city-wide nosocomial outbreak of W-strain TB in the early 1990s among New York AIDS patients. Other frequently seen strains were either also very resistant, or, surprisingly, pansusceptible. Individual MDR strains can be spread widely in situations where AIDS and TB are both common.

Keywords: New York; drug resistance, multiple drug resistance (MDR); outbreak; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA 2: Montefiore Medical Center, New York, USA 3: Department of Medicine, Bronx Lebanon Medical Center, New York, USA 4: Lincoln Hospital Medical and Mental Health Center, New York, USA 5: The Spellman Center, St. Clare's Hospital, New York, USA 6: St. Vincent's Hospital, New York, USA 7: NYU Medical Center, New York, USA 8: NYC Dept of Health, New York, USA 9: Department of Medicine, Columbia Presbyterian Medical Center, New York, USA 10: Mt. Sinai Medical Center, New York, USA 11: Cornel University Medical Center, New York, USA 12: King's County Hospital Medical Center, New York, USA 13: Veterans Administration Medical Center, Manhattan, New York, USA 14: Public Health Research Institute Tuberculosis Center, New York, USA

Publication date: April 1, 1997

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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