Reports on HIV/AIDS: 1990

OCTOBER 12, 1990, MMWR, Vol. 39, No. 40, pp. 718-722
should not be discharged to homes with immunocompromised persons or to
community group settings (e.g., correctional facilities, nursing homes, hospices, or
other organized group homes) unless AFB precautions can be provided. After patients
are discharged, they should be followed with serial sputum AFB smears to verify
continued bacteriologic response to therapy. When TB patients return for follow-up
care, provisions should be made to prevent TB transmission in the outpatient setting
(CDC, unpublished data).
Initial M. tuberculosis isolates from all patients should be tested for drug
susceptibility. Radiometric techniques may reduce the time required for culture and
drug- susceptibility testing (8). All drug-resistant isolates should be reported to care
providers rapidly so that adequate therapy can be ensured. All patients with
drug-resistant TB and all patients at high risk for noncompliance should be placed on
directly observed therapy.
Ventilation in AFB isolation rooms and other areas of health-care facilities should
be designed and maintained according to published guidelines (6; CDC, unpublished
data). Ideally, sputum induction and aerosolized pentamidine treatments should be
administered only in single-patient rooms or booths that have negative pressure
relative to adjacent areas and are exhausted directly outside (9). Direction of air flow
in patient isolation rooms, sputum induction rooms, and pentamidine rooms or
booths should be frequently monitored. All HCWs, including nonpatient-care workers
and volunteers, who have potential exposure to TB should participate in an organized
TB skin-testing program to identify infected HCWs who may be candidates for
preventive therapy and to monitor the effectiveness of infection-control practices (10;
CDC, unpublished data).
This outbreak was characterized by M. tuberculosis isolates resistant to the two
first-choice anti-TB drugs, INH and rifampin. Outbreaks of MDR-TB can be difficult and
expensive to control and are typically associated with prolonged morbidity and
increased mortality (11,12). Management of drug-resistant TB patients and their
contacts is complex and needs to be individualized with consideration of multiple
factors, including their immunologic status.
The extent of this problem nationally is not known because surveillance for
M. tuberculosis drug resistance is not routinely conducted. To better characterize the
problem, health departments should consider establishing surveillance for drugresistant M. tuberculosis. Outbreaks of drug-resistant TB should be reported through
state health departments to CDC's Division of Tuberculosis Control, Center for
Prevention Services (telephone [404] 639-2519), to help determine the extent of this
problem, identify risk factors, and develop and implement control measures.
References
1. Brennen C, Muder RR, Muraca PW. Occult endemic tuberculosis in a chronic care facility.
Infect Control Hosp Epidemiol 1988;9:548-52.
2. Catanzaro A. Nosocomial tuberculosis. Am Rev Respir Dis 1982;125:559-62.
3. Ehrenkranz NJ, Kicklighter JL. Tuberculosis outbreak in a general hospital: evidence of
airborne spread of infection. Arch Intern Med 1972;77:377-82.
4. Haley CE, McDonald RC, Rossi L, et al. Tuberculosis epidemic among hospital personnel.
Infect Control Hosp Epidemiol 1989;10:204-10.
5. Kantor HS, Poblete R, Pusateri SL. Nosocomial transmission of tuberculosis from unsuspected disease. Am J Med 1988;84:833-8.
6. Garner JS, Simmons BP. Guideline for isolation precautions in hospitals. Infect Control
1983;4(suppl): 245-325.

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