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Nosocomial Transmission of Tuberculosis
- Jordan B. Glaser, MD;
- Carol Bosholm, MD; and
- Dorothy Minucci, RN
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TO THE EDITOR:
We read with interest the recent article by Maloney and colleagues [1]. We have detected a similar increase and decrease in cases of multidrug-resistant tuberculosis at our institution; however, our experience contrasts with those described in their group's recent and previous articles [2]. The annual multidrug-resistant tuberculosis rates at our institution were 0 of 7 cases (0%) in 1990, 2 of 17 (12%) in 1991, 11 of 24 (46%) in 1992, 4 of 28 (15%) in 1993, and 4 of 22 (18%) in 1994. A significant increase (P < 0.05) and decrease (P < 0.04) for trend (chi-square test) was centered on 1992.
We are not convinced that the increase and decrease in drug-resistant tuberculosis rates seen in our institution were related to a hospital-based outbreak with subsequent initiation of improved control measures. Our employee tuberculin skin-test conversion rate has remained below 1% since 1990. Numerous reverse air-flow rooms have been available, and there has been a low threshold for isolating persons at risk for multidrug-resistant tuberculosis. Known exposures have mainly involved elderly persons with drug-sensitive tuberculosis, a finding described at another institution [3]. The decline of multidrug-resistant tuberculosis seen at our institution may have been related to improved community-based treatment programs [4]. Indeed, many patients with multidrug-resistant tuberculosis had received previous treatment with antituberculous medications (48%), which suggests acquired drug resistance rather than nosocomial infection.
Eighty-one percent of patients with multidrug-resistant tuberculosis had a history of ethanol or intravenous drug use, 48% were white, and 33% had private insurance. This finding is consistent with the demographic characteristics of Staten Island (population, 400 000), a predominantly white middle-class borough of New York City, and with our previous finding of a $43 000 median household income among HIV-infected intravenous drug users who live in Staten Island and have steady heterosexual partners [5]. Approximately 22 000 of the 200 000 intravenous drug users in New York State have an annual income of more than $25 000 [5]. Our experience shows that cases of multidrug-resistant tuberculosis will not remain confined to inner-city areas and reinforces the need for both institutionally based control measures and community-based, directly observed therapy programs in contiguous suburban areas.
Jordan B. Glaser, MD
Carol Bosholm, MD
Dorothy Minucci, RN
Staten Island University Hospital; Staten Island, NY 10305
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
