Int Conf AIDS. 1996 Jul 7-12;11(1):168 (abstract no. Mo.C.1660). Unique
From July 1992 to December 1995, 63 cases of MHTB were observed at
Infectious Diseases (ID) of our Hospital. ID is a facility with two
floors of inpatients (50-42 beds), Day- Hospital (6-12 beds), and an
outpatient ward (4-5000 visits per-year). Of all cases, 31 were due to
the same strain and were nosocomially acquired in the first 6 months of
1993. Overall distribution of MHTB was as follows: 7 in 1992 (last 6
months), 35 in 1993, 12 in 1994, 10 in 1995. 31 patients (nosocomial
outbreak) showed an identical pattern of drug resistance on antibiogram
(9 of 10 tested drugs: Rifampicin, Isoniazid, Ethambutol, Streptomicin,
Amikacin, Kanamicin, Cicloserin, Terizidon, Ofloxacin; only Piazofolin
was susceptible). After the outbreak, no patient with the same pattern
was identified except in one case when 4/4 tested drugs were resistant.
The patient, though, had no clear epidemiological link to the nosocomial
outbreak. 14 other patients were susceptible to at least 3 of 4 major
anti- MHTB drugs, but showed resistance to 2-6 other minor drugs. Of
these, clinical outcome and response to therapy were all favourable
except in two cases, regardless of risk, age or CD4 counts. Availability
of PCR testing (July 93), awareness of the peculiar course of MDR-TB,
reduced overcrowding in HIV ward, better spacing of facilities, precise
scheduling of outpatient work, rigid compliance to isolation measures
for febrile and respiratory patients, limitation of transportation
outside the building for diagnostic purposes, health care prevention
programs all allowed containment and eventual interruption of nosocomial
transmission. No health- care worker developed the disease. The
continuing presence of different strains of MDR-TB in 94- 95, though
unrelated to nosocomial acquisition, raises concern on the new potential
of a formerly treatable disease, especially in immunocompromised hosts
when no negative pressure facilities are available: enforcing strict
isolation procedures remains mandatory for such Institutions.
*Cross Infection *Tuberculosis, Multidrug-Resistant/EPIDEMIOLOGY