LETTER
Clusters of Multidrug-Resistant Tuberculosis
Brian R. Edlin, MD;
Sarah E. Valway, DMD; and
Ida M. Onorato, MD
1 January 1993 | Volume 118 Issue 1 | Page 77
TO THE EDITOR:
We wish to clarify a point made in our report on multidrug-resistant tuberculosis in the United States. By noting that clusters of multidrug-resistant tuberculosis cases had been reported from 12 U.S. hospitals [1], we did not mean that nosocomial transmission had been verified in each. Hospital clusters may result from outbreaks caused by transmission inside or outside the hospital. Transmission in the hospital may be implicated by epidemiologic associations between exposure in the hospital and the subsequent development of disease or by the demonstration of molecular genetic similarity between patient isolates [1].
As of 18 September 1992, clusters of multidrug-resistant tuberculosis were reported in 15 institutions, including 14 hospitals [1-3] (Centers for Disease Control. Unpublished data) and a prison system [4]. To date, investigations have implicated nosocomial transmission in eight of these institutions, including seven hospitals. Multidrug-resistant tuberculosis has been confirmed in at least 241 patients and 17 health care workers in these institutions. Control of nosocomial tuberculosis will require careful adherence to preventive measures [5].
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Author and Article Information
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Centers for Disease Control; Atlanta, GA 30333
1. Edlin BR, Tokars JI, Grieco MH, et al. An outbreak of multidrug-resistant tuberculosis among hospitalized patients with the acquired immunodeficiency syndrome. N Engl J Med. 1992; 326:1514-21.
2. Centers for Disease Control. Nosocomial transmission of multidrug-resistant tuberculosis among HIV-infected persons—Florida and New York, 1988-1991. MMWR. 1991; 40:585-91.
3. Centers for Disease Control. National action plan to combat multidrug-resistant tuberculosis; meeting the challenge of multidrug-resistant tuberculosis: summary of a conference. MMWR. 1992; 41(no.RR-11).
4. Centers for Disease Control. Transmission of multidrug-resistant tuberculosis among immunocompromised persons in a correctional system—New York, 1991. MMWR. 1992; 41:507-9.
5. Centers for Disease Control. Guidelines for preventing the transmission of tuberculosis in health-care settings, with special focus on HIV-related issues. MMWR. 1990; 39(no.RR-17).
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