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Volume 16, Number 9—September 2010

Research

Determinants of Multidrug-Resistant Tuberculosis Clusters, California, USA, 2004–2007

John Z. MetcalfeComments to Author , Elizabeth Y. Kim, S.-Y. Grace Lin, Adithya Cattamanchi, Peter Oh, Jennifer Flood, Philip C. Hopewell, and Midori Kato-Maeda
Author affiliations: Author affiliations: University of California, San Francisco, California, USA (J.Z. Metcalfe, E.Y. Kim, A. Cattamanchi, P.C. Hopewell, M. Kato-Maeda); California Department of Public Health, Richmond, California, USA (S.-Y.G. Lin, P. Oh, J. Flood)

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Table 1

Demographic and clinical characteristics of 123 patients with clustered and nonclustered MDR TB infections, California, USA, 2004–2007*

Characteristic Nonclustered, n = 98† Clustered, n = 25† OR‡ (95% CI) p value
Median age, y (IQR) 39 (30–50) 27 (18–53) 0.05
Female gender
47 (48)
11 (44)
0.9 (0.3–2.3)
0.72
Foreign birth 92 (94) 21 (84) 0.3 (0.1–1.8) 0.11
Nation or region of origin
Philippines 20 (20) 1 (4) <0.001
Mexico 16 (16) 5 (20)
Vietnam 14 (14) 1 (4)
China 12 (12) 0
Central America 6 (6) 0
India 3 (3) 3 (12)
Laos 2 (2) 6 (24)
Thailand 1 (1) 4 (16)
United States 6 (6) 4 (16)
All other nations§ 18 (18) 1 (4)
Recent immigration from refugee setting
4 (4)
7 (28)
9.1 (2–45)
<0.001
Median time from US entry to diagnosis, y (IQR) 2.4 (0.2–8.7) 4.2 (0.2–11) 0.77
Time from US entry to MDR diagnosis¶
<3 mo 25 (27) 6 (29) 0.42
3 mo–3 y 25 (27) 4 (19)
>3 y
40 (44)
11 (52)


Known HIV/TB co-infection
3 (6)
0


Private healthcare provider 11 (11) 4 (16) 1.3 (0.3–5.4) 0.74
Homelessness
6 (6)
1 (4)
0.7 (0.01–5.9)
1.0
Previous active TB 28 (29) 7 (28) 1.0 (0.3–2.9) 1.0
Sputum-positive AFB smear
60 (66)
16 (70)
1.2 (0.4–3.8)
0.81
Extrapulmonary disease# 7 (7) 1 (4) 0.6 (0.1–3.9) 1.0
Cavitary disease
25 (26)
10 (42)
1.9 (0.7–5.8)
0.22
Median time to culture conversion, mo (IQR) 2.2 (1.3–4.6) 3 (1.4–4.4) 0.57
Median total treatment time, mo (IQR)
25.8 (21.4–28.9)
24.4 (22.6–27.3)

0.56
Treatment failure** 4 (7) 1 (6) 0.9 (0.02–9.7) 0.56
Treatment outcome†† 0.70
Completed treatment 70 (83) 17 (81)
Moved 7 (8) 1 (5)
Defaulted 2 (2) 0
Died 5 (6) 3 (14)

*MDR TB, multidrug-resistant tuberculosis; OR, odds ratios; CI, confidence interval; IQR, interquartile range; AFB, acid-fast bacilli. – indicates OR had no meaning for those specific comparisons.
†Values are no. (%) except as indicated.
‡ORs describe the association between the characteristic of interest and MDR TB case-clustered status. The denominator for each characteristic excludes missing or unknown values.
§Afghanistan (1), Burma (1), Cambodia (5), Ethiopia (1), Indonesia (1), Mongolia (1), Nepal (1), Peru (2), South Korea (5), and Ukraine (1).
¶Date of US entry was missing for 2 persons.
#Nonclustered cases: cervical lymph node (5), bone (1), other (1); clustered cases: pleural (1).
**Culture positive after >8 months of treatment; limited to pulmonary TB patients who were alive at diagnosis and had an initial positive sputum culture.
††Treatment outcome available for 105 (85%) cases.

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