Colson, M. Revuelta), Methodist Hospital Research Institute, Houston, Texas, USA (E.A.

Each site identified cases of MDR TB and extensively drug-resistant (XDR) TB reported to CDC during 2005–2007. %PDF-1.5 %����

Extensive DST of first-line and second-line medications was conducted within 2 months of treatment initiation for most patients. Among patients alive at diagnosis, a median of 1 adverse event (average 2.9) resulted in medication change or adjustment, but only 2 patients completely stopped treatment.

Saving Lives, Protecting People, Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.M.

In this population-based sample, which comprised 36% (130/364) of MDR TB and 56% (5/9) of XDR TB cases reported in the United States during 2005–2007, MDR/XDR TB diagnosis and treatment were very complex: M. tuberculosis isolates were resistant to a large number of medications, care was complicated by extensive disease and by concurrent conditions, and patients were highly infectious.

With health care reform, a substantial proportion of uninsured TB patients are expected to become eligible for Medicaid coverage, which should increase access to health care and early TB diagnosis and decrease TB-associated hospitalizations and deaths. American Thoracic Society, CDC, and Infectious Diseases Society of America.

Percentage of 135 patients for whom Mycobacterium tuberculosis isolates had the following mutually exclusive resistance patternsINH/RIF/RBT-only, resistant to isoniazid (INH)/rifampin (RIF)/rifabutin (RBT) only; INH/RIF/RBT-plus, resistant to a median of 4... At various times during treatment, M. tuberculosis isolates were tested for susceptibility (median 14 medications, range 4–19) and were resistant to several (median 5 medications, range 2–16) at any time during treatment. Among symptomatic patients, initial TB diagnosis was made relatively quickly, within 7 weeks of symptom onset.

Acquisition of any drug resistance during treatment occurred for 21% of patients and was more likely to occur in populations difficult to treat (those who had pre-XDR TB or XDR TB or were homeless), suggesting a need for more vigilant treatment monitoring. Case management services were also intensive; a case manager was assigned to ≈90% of patients. Direct costs averaged $134,000 (SE $9,683) per MDR TB patient and $430,000 (SE $73,109) per XDR TB patient.

DST was conducted for first-line drugs during the first month of treatment, for second-line drugs during the second month of treatment, for linezolid during the fourth month, and for clofazimine during the seventh month. Flood, K. Salcedo, P. Oh), Texas Department of State Health Services, Tyler, Texas, USA (B. Seaworth, L. Armitige, K. Sheeran), University of Texas Health Science Center, Tyler (B. Seaworth, L. Armitige, K. Sheeran), ICAP/Columbia University, New York, New York, USA (Y. Hirsch-Moverman, P.W.

Inpatient costs were measured; outpatient costs and productivity losses were estimated (Technical Appendix). 126 0 obj <>/Filter/FlateDecode/ID[<4E9DBEAE23065141979A1184DC55E000><41DD03EAA85FBD49AD7C857B8A0114C4>]/Index[107 41]/Info 106 0 R/Length 100/Prev 482659/Root 108 0 R/Size 148/Type/XRef/W[1 3 1]>>stream In this population-based sample of MDR/XDR TB patients in the United States, despite the extensive drug resistance found at the time of diagnosis, culture conversion and treatment completion rates were high and mortality rates were low. We estimated direct and productivity-loss costs and examined associated characteristics by using multivariable linear regression with backward selection.

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