Objective: To determine the factors associated with the development of multidrug-resistant tuberculosis among patients at a New York City Hospital and to investigate possible nosocomial transmission.

Design: A retrospective case-control study and tuberculin skin test survey.

Patients: Twenty-three patients with tuberculosis whose isolates were resistant to at least isoniazid and rifampin (case patients) were compared with patients with tuberculosis whose isolates were susceptible to all agents tested (controls). Tuberculin skin test conversion rates were compared among health care workers assigned to wards where patients with tuberculosis were frequently or rarely admitted.

Setting: A large, teaching hospital in New York City.

Measurements:Mycobacterium tuberculosis isolates from case patients and controls were typed by restriction fragment length polymorphism analysis.

Results: Case patients were younger (median age, 34 compared with 42 years; P = 0.006), more likely to be seropositive for HIV (21 of 23 compared with 11 of 23 patients; odds ratio, 11.5; 95% Cl, 1.9 to 117), and more likely to have had a previous hospital admission within 7 months before the onset of tuberculosis (19 of 23 compared with 5 of 23 patients; odds ratio, 17.1 ; Cl, 3.3 to 97), particularly on one ward (12 of 23 compared with 0 of 23 patients; odds ratio, undefined; P = 0.002). Health care workers assigned to wards housing case patients were more likely to have tuberculin skin test conversions than were health care workers assigned to other wards (11 of 32 compared with 1 of 47 health care workers; P < 0.001). Few (6 of 23) case patients were placed in acid-fast bacilli isolation, and no rooms tested had negative pressure. Of 16 available multi-drug-resistant isolates obtained from case patients, 14 had identical banding patterns by restriction fragment length polymorphism analysis. In contrast, M. tuberculosis isolates from controls with drug-susceptible tuberculosis had patterns distinct from each other and from those of case patients.

Conclusions: These data suggest nosocomial transmission of multidrug-resistant tuberculosis occurred from patient to patient and from patient to health care worker and underscore the need for effective acid-fast bacilli isolation facilities and adherence to published infection control guidelines in health care institutions.


  • 1. Jereb J, Kelly G, Doley S, Cauthen G, and Snider D . Tuberculosis mortality in the United States: Final data, 1990. MMWR. 1991;40:23-7. Google Scholar
  • 2. Emergence of drug-resistant Mycobacterium tuberculosis in HIV-infected patients. Lancet. 1991;337:852. CrossrefGoogle Scholar
  • 3. Shafer R, Chirgwin K, Glatt A, Dahdouh M, Landesman S, and Suster B . HIV prevalence, immunosuppression, and drug resistance in patients with tuberculosis in an area endemic for AIDS. AIDS. 1991;5:399-405. CrossrefMedlineGoogle Scholar
  • 4. . Screening for tuberculosis and tuberculosis in high-risk populations, and the use of preventive therapy for tuberculosis infection in the United States: Recommendations of the Advisory Committee for the Elimination of Tuberculosis. MMWR. 1990;39:1-12(no. RR-8). MedlineGoogle Scholar
  • 5. Dean A, Dean J, Burton J, and Dicker R . Epi Info, Version 5.01b; a word processing, database, and statistics program for epidemiology on microcomputers. Atlanta: Centers for Disease Control; 1991. Google Scholar
  • 6. Kent P and Kubica G . Public Health Mycobacteriology: A Guide for the Level III Laboratory. Atlanta: U.S. Department of Health and Human Services; 1985:166-74. Google Scholar
  • 7. Cave M, Eisenach K, McDermott P, Bates J, and Crawford J . IS6110: conservation of sequence in the Mycobacterium tuberculosis complex and its utilization in DNA fingerprinting. Molecular and Cellular Probes. 1991;5:73-80. CrossrefMedlineGoogle Scholar
  • 8. . Guidelines for preventing the transmission of tuberculosis in health-care settings, with special focus on HIV-related issues. MMWR. 1990;39:1-29 (no. RR-17). MedlineGoogle Scholar
  • 9. Gurdip F, Tamara M, Antoniskis D, and Barnes P . Undiagnosed tuberculosis in patients with human immunodeficiency virus infection. Chest. 1990;98:1056-9. CrossrefMedlineGoogle Scholar
  • 10. Noble R . Infectiousness of pulmonary tuberculosis after starting chemotherapy: Review of the available data on an unresolved question. Am J Infect Control. 1981;9:6-10. CrossrefGoogle Scholar
  • 11. . Nosocomial transmission of multidrug-resistant tuberculosis among HIV-infected persons—Florida and New York, 1988-1991. MMWR. 1991;40:585-91. MedlineGoogle Scholar
  • 12. . Transmission of multidrug-resistant tuberculosis from an HIV-positive client in a residential substanceabuse treatment facility. MMWR. 1991;40:129-31. MedlineGoogle Scholar

This content is PDF only. To continue reading please click on the PDF icon.