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PubMed · 8089468

Mycobacterium-avium complex.

D S Rubin·J J Rahal
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Abstract

The ubiquitous MAC causes disseminated disease in a large proportion of patients with AIDS. It will become an increasingly important clinical pathogen as more patients survive within the context of prolonged immunodeficiency. The primary risk factor for DMAC is CD4 < 100 mm3 and thus the institution of adequate prophylaxis will significantly reduce its presentation in advanced HIV infection. For those patients presenting with DMAC, therapy with a multiple drug regimen including a macrolide is indicated. Because of potential toxicities and interactions in these debilitated patients, however, the ideal approach is to employ a minimum number of drugs with maximal clinical activity.

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AIDS-Related Opportunistic InfectionsHumansMycobacterium avium-intracellulare InfectionJournal ArticleReview

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D S Rubin, J J Rahal. 1994. Mycobacterium-avium complex.. https://pubmed.ncbi.nlm.nih.gov/8089468/

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A continuing survey of drug-resistant tuberculosis, New York City, April 1994.

BACKGROUND: A 1991 survey showed high levels of drug resistance among tuberculosis patients in New York, NY. As a result, the tuberculosis control program was strengthened, including expanded use of directly observed therapy and improved infection control. METHODS: We collected isolates from every patient in New York City with a positive culture for Mycobacterium tuberculosis during April 1994; results were compared with those in the April 1991 survey. RESULTS: From 1991 to 1994, the number of patients decreased from 466 to 332 patients. The percentage with isolates resistant to 1 or more antituberculosis drugs decreased from 33% to 24% (P < .01); with isolates resistant to at least isoniazid decreased from 26% to 18% (P < .05); and with isolates resistant to both isoniazid and rifampin decreased from 19% to 13% (P < .05). The number of patients with isolates resistant to both isoniazid and rifampin decreased by more than 50%. Among never previously treated patients, the percentage with resistance to 1 or more drugs decreased from 22% in 1991 to 13% in 1994 (P < .05). The number of patients with consistently positive culture results for more than 4 months decreased from 130 to 44. A history of antituberculosis treatment was the strongest predictor of drug resistance (odds ratio = 3.1; P < .001). Human immunodeficiency virus infection was associated with drug resistance among patients who never had been treated for tuberculosis. CONCLUSIONS: Drug-resistant tuberculosis declined significantly in New York City from 1991 to 1994. Measures to control and prevent tuberculosis were associated with a 29% decrease in the proportion of drug resistance and a 52% decrease in the number of patients with multidrug-resistant tuberculosis.

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