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West J Med. 1995 November; 163(5): 441–445.
PMCID: PMC1303167

Drug-resistant Mycobacterium tuberculosis in California, 1991 to 1992.


To determine the proportion and distribution of drug-resistant Mycobacterium tuberculosis in California, we surveyed all California counties for drug-susceptibility test results for initial isolates from tuberculosis cases counted during the first quarters of 1991 and 1992. Overall, drug-susceptibility test results were not available for 17% of isolates. Among isolates with available test results, the proportion with resistance to isoniazid averaged 8.7%, and the proportion with resistance to at least 2 drugs, multidrug resistance, averaged 5.9% during these two quarters. The proportion of isolates with drug resistance did not change substantially during these time periods. The proportion with combined isoniazid and rifampin resistance remained stable at about 1.1%. Among persons whose isolates were tested for drug resistance, those with a known previous diagnosis of tuberculosis (relative risk [RR] = 2.6; 95% confidence interval [CI], 1.6 to 4.3; P < .01) and persons who were foreign born (RR = 1.7; 95% CI, 1.1 to 2.7; P = .014) were more likely to have isoniazid-resistant organisms. These statewide data suggest that the initial tuberculosis treatment regimen in California should include 4 antituberculosis drugs, as recommended by the American Thoracic Society and the Centers for Disease Control and Prevention for areas with a prevalence of isoniazid resistance of 4% or greater. The lack of test results for 1 in 6 patients with tuberculosis suggests the need for improved physician and laboratorian education to implement the recommendations that drug susceptibility be tested on all initial isolates.

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Selected References

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  • Kopanoff DE, Kilburn JO, Glassroth JL, Snider DE, Jr, Farer LS, Good RC. A continuing survey of tuberculosis primary drug resistance in the United States: March 1975 to November 1977. A United States Public Health Service cooperative study. Am Rev Respir Dis. 1978 Nov;118(5):835–842. [PubMed]
  • Snider DE, Jr, Cauthen GM, Farer LS, Kelly GD, Kilburn JO, Good RC, Dooley SW. Drug-resistant tuberculosis. Am Rev Respir Dis. 1991 Sep;144(3 Pt 1):732–732. [PubMed]
  • Fischl MA, Uttamchandani RB, Daikos GL, Poblete RB, Moreno JN, Reyes RR, Boota AM, Thompson LM, Cleary TJ, Lai S. An outbreak of tuberculosis caused by multiple-drug-resistant tubercle bacilli among patients with HIV infection. Ann Intern Med. 1992 Aug 1;117(3):177–183. [PubMed]
  • Pearson ML, Jereb JA, Frieden TR, Crawford JT, Davis BJ, Dooley SW, Jarvis WR. Nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis. A risk to patients and health care workers. Ann Intern Med. 1992 Aug 1;117(3):191–196. [PubMed]
  • Barnes PF. The influence of epidemiologic factors on drug resistance rates in tuberculosis. Am Rev Respir Dis. 1987 Aug;136(2):325–328. [PubMed]
  • Riley LW, Arathoon E, Loverde VD. The epidemiologic patterns of drug-resistant Mycobacterium tuberculosis infections: a community-based study. Am Rev Respir Dis. 1989 May;139(5):1282–1285. [PubMed]
  • Bloch AB, Cauthen GM, Onorato IM, Dansbury KG, Kelly GD, Driver CR, Snider DE., Jr Nationwide survey of drug-resistant tuberculosis in the United States. JAMA. 1994 Mar 2;271(9):665–671. [PubMed]
  • Frieden TR, Sterling T, Pablos-Mendez A, Kilburn JO, Cauthen GM, Dooley SW. The emergence of drug-resistant tuberculosis in New York City. N Engl J Med. 1993 Feb 25;328(8):521–526. [PubMed]

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