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(Chest. 2001;120:1514-1519.)
© 2001 American College of Chest Physicians

Increased Incidence of Multidrug-Resistant Tuberculosis in Diabetic Patients on the Bellevue Chest Service, 1987 to 1997*

Mona Bashar, MD; Phil Alcabes, PhD; William N. Rom, MD, MPH, FCCP and Rany Condos, MD

* From Bellevue Chest Service (Drs. Bashar, Rom, and Condos), Division of Pulmonary and Critical Care Medicine, Department of Medicine and Environmental Medicine, New York University School of Medicine, New York; and Program in Urban Public Health (Dr. Alcabes), Hunter College School of Health Sciences, City University of New York, New York, NY.

Correspondence to: Rany Condos, MD, Division of Pulmonary and Critical Care Medicine, Department of Medicine, New York University School of Medicine, 550 First Ave, NB 7N24, New York, NY 10016; e-mail: condor01{at}gcrc.med.nyu.edu

Study objectives: To investigate the characteristics of tuberculosis infection in diabetic patients at Bellevue Hospital.

Design: We conducted a case-control study retrospectively reviewing the records of patients at Bellevue Hospital Center from 1987 to 1997 with a discharge diagnosis of tuberculosis and diabetes mellitus.

Setting: Bellevue Hospital Center is a 1,200-bed, inner-city municipal hospital located in the Lower East Side of New York City.

Patients: Fifty-three identified patients had verified tuberculosis infection and diabetes; of these, 50 charts were available for review. One hundred five control cases were selected from nondiabetic patients with a discharge diagnosis of tuberculosis during the same time period.

Measurements and results: Thirty-six percent (18 cases) of the patients with diabetes and tuberculosis had multidrug-resistant tuberculosis (MDR-TB) compared to only 10% (10 cases) in the control group (p < 0.01) Controlling for homelessness, HIV status, and directly observed therapy, the relative risk of MDR-TB was calculated to be 8.6 (confidence interval, 3.1 to 23.6) in the diabetic group compared to the control group.

Conclusions: There was a significant association between diabetes and MDR-TB. Diabetes continues to be a risk factor for tuberculosis and was associated with MDR-TB in our patients.

Key Words: diabetes mellitus • multidrug-resistant tuberculosis




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