MULTIDRUG-RESISTANT TUBERCULOSIS

Large outbreaks of multidrug-resistant tuberculosis have recently occurred in hospitals and correctional facilities. Mortality in these outbreaks has been extraordinarily high, and more than 80% of cases have occurred in persons infected with the human immunodeficiency virus (HIV). At least eight health care workers at these hospitals have developed active multidrug-resistant tuberculosis. Conditions contributing to these outbreaks include poor compliance with antituberculosis therapy leading to development of drug-resistant organisms; contact between immunocompromised persons and those with infectious tuberculosis; and inadequate infection control practices and isolation facilities. To prevent further outbreaks, steps should be taken to ensure that patients with tuberculosis adhere to the prescribed drug regimen to prevent the development of drug-resistant tuberculosis, and Centers for Disease Control (CDC) guidelines for reducing tuberculosis transmission should be implemented immediately. A federal tuberculosis task force has been established and has developed a national action plan to address the problem of multidrug-resistant tuberculosis.