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Volume 16, Number 2—February 2010

Research

Emergence of Increased Resistance and Extensively Drug-Resistant Tuberculosis Despite Treatment Adherence, South Africa

Alistair D. Calver1, Alecia A. Falmer1, Megan Murray, Odelia J. Strauss, Elizabeth M. Streicher, Madelene Hanekom, Thelma Liversage, Mothusi Masibi, Paul D. van Helden, Robin M. Warren, and Thomas C. VictorComments to Author 
Author affiliations: West Vaal Hospital, Orkney, South Africa (A.D. Calver, T. Liversage, M. Masibi); Stellenbosch University, Tygerberg, South Africa (A.A. Falmer, O.J. Strauss, E.M. Streicher, M. Hanekom, P.D. van Helden, R.M. Warren, T.C. Victor); Harvard School of Public Health, Boston, Massachusetts, USA (M. Murray)

Main Article

Table 2

Patient risk factors for having clustered TB isolates, January 2003–January 2005, South Africa*†

Category Cluster status
Univariate OR p value Multivariate OR p value
Unique, n = 50 Clustered, n = 74
Treatment history
Re-treatment 25 44
New case
25
30
1.47
0.29
0.69
0.50
Sex
M 49 71
F
1
3
1.27
0.52
NI

Age, y
<45 33 51
>45
17
23
0.87
0.73
NI

HIV status
Negative 4 3
Positive
29
53
2.43
0.26
2.33
0.33
Sputum smear
Negative 14 19
Positive
36
55
1.12
0.77
NC

MDR TB
Mono or poly resistant 16 2
INH and RIF resistant
34
72
14.2
0.001
14.13
0.002
MDR plus
Mono or poly resistant 16 2
Pre–XDR TB/XDR TB
7
24
27.42
<0.001
NC

Died
No 38 42
Yes
12
32
2.28
0.04
4.76‡
0.007‡
CD4 count, cells/mm3
<200 15 42
>200 8 11 0.49 0.19 0.51§ 0.28

*TB, tuberculosis; OR, odds ratio; CI, confidence interval; NI, variables not included in final logistic regression model based on model selection criteria; NC, variables a priori not considered in logistic regression model; MDR, multidrug-resistant; XDR, extensively drug-resistant; INH, isoniazid; RIF, rifampin.
†Logistic regression performed on 71 observations for which HIV and CD4 available, model adjusted for treatment history, HIV, CD4, and MDR.
‡Logistic regression on probability of death given clustering, adjusting for HIV, MDR-plus, and age.
§CD4 counts available for 77 patients only.

Main Article

1These authors contributed equally to this article.

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