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Human tuberculosis (MHTB) and multidrug-resistance: clinicoepidemiological remarks following a nosocomial outbreak.
Caggese L; Volonterio A; Orcese C; Penati V; Astolfi A; Rastrelli M;
January 30, 1997
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