Treatment Practices, Outcomes, and Costs of Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis, United States, 2005–2007 - Volume 20, Number 5—May 2014 - Emerging Infectious Disease journal - CDC
Volume 20, Number 5—May 2014
Treatment Practices, Outcomes, and Costs of Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis, United States, 2005–2007
Suzanne M. Marks , Jennifer Flood, Barbara Seaworth, Yael Hirsch-Moverman, Lori Armstrong, Sundari Mase, Katya Salcedo, Peter Oh, Edward A. Graviss, Paul W. Colson, Lisa Armitige, Manuel Revuelta, Kathryn Sheeran, and the TB Epidemiologic Studies Consortium
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.M. Marks, L. Armstrong, S. Mase, TB Epidemiologic Studies Consortium); California Department of Public Health, Richmond, California, USA (J. Flood, K. Salcedo, P. Oh); Texas Department of State Health Services, Tyler, Texas, USA (B. Seaworth, L. Armitige, K. Sheeran); University of Texas Health Science Center, Tyler (B. Seaworth, L. Armitige, K. Sheeran); ICAP/Columbia University, New York, New York, USA (Y. Hirsch-Moverman, P.W. Colson, M. Revuelta); Methodist Hospital Research Institute, Houston, Texas, USA (E.A. Graviss)
Drug-resistant Mycobacterium tuberculosis poses substantial obstacles to tuberculosis (TB) control. In the United States, multidrug-resistant (MDR) TB (resistant to at least isoniazid and rifampin) comprises only 1.0%–1.5% of TB cases but requires lengthy regimens of toxic drugs, imposes high costs on the health care system and society, and causes high mortality rates.
Studies of MDR TB in the United States have been limited by small sample sizes, limited study periods, minimal information on outcomes and costs, or reliance solely on surveillance data (1–6), which omit some cases of acquired drug resistance and changes in regimens. Costs of treating MDR TB are not routinely collected or reported.
Our study describes and analyzes characteristics associated with drug resistance, timely diagnosis, treatment practices, outcomes, and costs associated with MDR TB for cases reported to the Centers for Disease Control and Prevention (CDC) by California, New York, NY, and Texas during 2005–2007. These 3 areas contribute about half of US MDR TB cases annually.
CDC and local institutional review boards approved the study and granted a waiver of patient informed consent and patient authorization. We defined a 5-drug regimen (Technical Appendix [PDF - 300 KB - 24 pages]) to be consistent with US and World Health Organization recommendations (7,8). All study definitions are in the Technical Appendix [PDF - 300 KB - 24 pages].