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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 B. 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.

Page created: December 13, 2010
Page updated: December 13, 2010
Page reviewed: December 13, 2010
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