Transmission of Multidrug-Resistant Mycobacterium tuberculosis among Persons with Human Immunodeficiency Virus Infection in an Urban Hospital: Epidemiologic and Restriction Fragment Length Polymorphism Analysis

Abstract

From January 1990 to December 1991, 16 patients with multidrug-resistant tuberculosis (MDR-TB) caused by Mycobacterium tuberculosis resistant to isoniazid, rifampin, and streptomycin were diagnosed at Elmhurst Hospital. Compared with other TB patients, MDR-TB patients were more likely to have human immunodeficiency virus (HIV) infection (14/16 vs. 21/204, P < .001) and a prior admission (10/16 vs. 3/204, P < .001). HIV-infected patients hospitalized for > 10 days within three rooms of an infectious MDR-TB patient had higher risk of acquiring MDR-TB than did HIV-infected patients with shorter hospitalizations or locations further from the MDR-TB patient(s) (6/28 vs. 2/90, P < .001). Isolates of 6 of 8 MDR-TB patients in a chain of transmission were identical by restriction fragment length polymorphism DNA typing. Ambulation on the wards of inadequately masked TB patients and lack of negative pressure in isolation rooms probably facilitated transmission. This report documents nosocomial transmission of MDR-TB and underscores the need for effective isolation practices and facilities in health care institutions.

Prediction of Drug Resistance in M. tuberculosis: Molecular Mechanisms, Tools, and Applications

“…Multidrug resistance (MDR, resistant to at least INH and RIF) will thus occur mainly in circumstances where treatment is not optimal. Reports of nosocomial outbreaks of MDR-TB in institutions such as hospitals (10)(11)(12)(13) and prisons (14) and in the United States, Europe, and developing countries (15,16) have focused attention on MDR-TB as a major health issue. Infection followed by active MDR-TB in health care workers after exposure to patients with MDR-TB (17)(18)(19), and outbreaks within communities have also been reported (20)(21)(22).…”

Determinants of cluster distribution in the molecular epidemiology of tuberculosis

“…Nowhere has this approach been used more rigorously than in the pioneering work on the molecular epidemiology of tuberculosis (TB). Since the development of standardized methods for DNA fingerprinting of Mycobacterium tuberculosis, molecular techniques have been used to estimate the fraction of cases attributable to recent transmission of M. tuberculosis (7)(8)(9)(10)(11)(12)(13)(14), identify host-specific risk factors for disease spread (15)(16)(17)(18), document exogenous reinfection (19)(20)(21), and study patterns of drug resistance (22)(23)(24). Investigators also have begun to use these methods to explore potential strain-specific differences in bacterial phenotypes such as tissue tropism, virulence, and transmissibility (25,26).…”

Infektionsprävention im Rahmen der Pflege und Behandlung von Patienten mit übertragbaren Krankheiten

“…Eine Voraussetzung für aerogene Übertragung ist, dass die entsprechenden Mikroorganismen unter diesen Bedingungen über längere Zeit infektiös bleiben. Dann sind Übertragungen auch auf Personen mög-lich, die sich in unterschiedlichen Räumen befinden oder die sich zu unterschiedlichen Zeiten im gleichen Raum aufhalten [81][82][83]. Beispiel für aerogen übertrag-bare Infektionen sind Masern, Varizellen und die offene Tuberkulose der Atemwege.…”