Risk factors for rifampin-monoresistant tuberculosis : A case-control study

• Published in: American journal of respiratory and critical care medicine 1999-02, Vol.159 (2), p.468-472
• Main Authors: SANDMAN, L, SCHLUGER, N. W, DAVIDOW, A. L, BONK, S
• Format: Article
• Language: English
• Subjects: Adult; Aged; AIDS-Related Opportunistic Infections - diagnosis; AIDS-Related Opportunistic Infections - drug therapy; AIDS-Related Opportunistic Infections - microbiology; AIDS/HIV; Antibacterial agents; Antibiotics, Antitubercular - therapeutic use; Antibiotics. Antiinfectious agents. Antiparasitic agents; Biological and medical sciences; Case-Control Studies; CD4 Lymphocyte Count; Drug Resistance, Microbial; Female; Follow-Up Studies; HIV - immunology; HIV Seropositivity - diagnosis; Humans; Length of Stay; Male; Medical sciences; Middle Aged; Mycobacterium tuberculosis - drug effects; Mycobacterium tuberculosis - isolation & purification; Pharmacology. Drug treatments; Rifampin - therapeutic use; Risk Factors; Treatment Outcome; Tuberculosis, Pulmonary - diagnosis; Tuberculosis, Pulmonary - drug therapy; Tuberculosis, Pulmonary - microbiology
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/ajrccm.159.2.9805097

Rifampin is the cornerstone of short-course chemotherapy for the treatment of tuberculosis (TB). Rifampin monoresistance (RMR) is less common than resistance to isoniazid alone or in combination with other antituberculous medications. We conducted a retrospective case-control study to identify risk factors for RMR-TB. Complete records for 21 of a total of 26 RMR patients from 1990 to 1997 were available for review, and were compared with those of 48 patients with drug-susceptible TB, controlling for year of diagnosis. Cases more frequently had a history of TB than did controls (61% versus 22%, p < 0.01), and were more often human immunodeficiency virus (HIV) positive (81% versus 46%, p = 0.02). With control for HIV status, cases were more likely to have extrapulmonary involvement (47.6% versus 11.6%, p = 0.05). Four cases (19%) and one control (2. 1%) died (p = 0.02) during hospitalization. Cases more often had a history of incarceration (71.4% versus 37.5%, p = 0.09). Among the 13 cases with a history of TB, five had evidence of malabsorption (vomiting and/or diarrhea), versus none of the 11 controls with prior TB. These data support the hypothesis that RMR is seen primarily in individuals with a history of TB and who are HIV positive. Cases were frequently noncompliant with previous treatment for TB, had a history of incarceration, and had poor outcomes.