• Suzanne M Marks, Jennifer Flood, Barbara Seaworth, Yael Hirsch-Moverman, Lori Armstrong, Sundari Mase, Katya Salcedo, Peter Oh, Edward A Graviss, Paul W Colson, Lisa Armitige, Manuel Revuelta, Kathryn Sheeran, and TB Epidemiologic Studies Consortium.
• Emerging Infect. Dis. 2014 May 1;20(5):812-21.

AbstractTo describe factors associated with multidrug-resistant (MDR), including extensively-drug-resistant (XDR), tuberculosis (TB) in the United States, we abstracted inpatient, laboratory, and public health clinic records of a sample of MDR TB patients reported to the Centers for Disease Control and Prevention from California, New York City, and Texas during 2005-2007. At initial diagnosis, MDR TB was detected in 94% of 130 MDR TB patients and XDR TB in 80% of 5 XDR TB patients. Mutually exclusive resistance was 4% XDR, 17% pre-XDR, 24% total first-line resistance, 43% isoniazid/rifampin/rifabutin-plus-other resistance, and 13% isoniazid/rifampin/rifabutin-only resistance. Nearly three-quarters of patients were hospitalized, 78% completed treatment, and 9% died during treatment. Direct costs, mostly covered by the public sector, averaged $134,000 per MDR TB and $430,000 per XDR TB patient; in comparison, estimated cost per non-MDR TB patient is $17,000. Drug resistance was extensive, care was complex, treatment completion rates were high, and treatment was expensive.

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