Am. J. Respir. Crit. Care Med.,
Volume 159, Number 2, February 1999, 468-472
Risk Factors for Rifampin-monoresistant Tuberculosis
A Case-Control Study
LAURIE
SANDMAN,
NEIL W.
SCHLUGER,
AMY L.
DAVIDOW,
and
STANLEY
BONK
Division of Pulmonary and Critical Care Medicine, Department of Environmental Medicine, and Department of Pathology,
New York University School of Medicine, New York, New York
Rifampin is the cornerstone of short-course chemotherapy for the treatment of tuberculosis (TB).
Rifampin monoresistance (RMR) is less common than resistance to isoniazid alone or in combination with other antituberculous medications. We conducted a retrospective case-control study to identify
risk factors for RMR-TB. Complete records for 21 of a total of 26 RMR patients from 1990 to 1997 were available for review, and were compared with those of 48 patients with drug-susceptible TB,
controlling for year of diagnosis. Cases more frequently had a history of TB than did controls (61% versus 22%, p < 0.01), and were more often human immunodeficiency virus (HIV) positive (81% versus 46%, p = 0.02). With control for HIV status, cases were more likely to have extrapulmonary involvement (47.6% versus 11.6%, p = 0.05). Four cases (19%) and one control (2.1%) died (p = 0.02)
during hospitalization. Cases more often had a history of incarceration (71.4% versus 37.5%, p = 0.09). Among the 13 cases with a history of TB, five had evidence of malabsorption (vomiting and/or
diarrhea), versus none of the 11 controls with prior TB. These data support the hypothesis that RMR
is seen primarily in individuals with a history of TB and who are HIV positive. Cases were frequently
noncompliant with previous treatment for TB, had a history of incarceration, and had poor outcomes.
