The New England Journal of Medicine, 1993;328:521-6. In New York City, the incidence of tuberculosis increased significantly over the past decade, with more than double the number of cases compared to previous years. The study analyzed data from 518 patients with positive tuberculosis cultures in April 1991, finding that 33% had isolates resistant to one or more antituberculosis drugs, 26% to isoniazid, and 19% to both isoniazid and rifampin. Among patients who had previously received treatment, 40% had resistant isolates, and 30% had isolates resistant to both isoniazid and rifampin. Patients infected with HIV or who used injection drugs were more likely to have resistant isolates. Those with resistant isolates were more likely to die, with 80% of HIV-positive patients dying compared to 47% of those without HIV. The study found that previous treatment was the strongest predictor of drug resistance. Patients who had been treated for less than 2 months had a 7% resistance rate, those treated for 2-14 months had 19%, and those treated for more than 14 months had 39%. The case fatality rate was 27% overall, with 26% of previously treated patients and 27% of untreated patients dying. Patients with AIDS were more likely to die, with 80% of those with resistant isolates dying compared to 47% of those without. The study highlights the increasing prevalence of drug-resistant tuberculosis in New York City, with a significant rise in the proportion of patients with resistant isolates. The findings suggest that drug-resistant tuberculosis is a growing public health concern, particularly among previously treated patients, those infected with HIV, and injection drug users. The study recommends measures to control and prevent drug-resistant tuberculosis, including improved treatment adherence and surveillance. The results also emphasize the need for improved public health infrastructure and access to medical care to address the rising incidence of tuberculosis and drug resistance.The New England Journal of Medicine, 1993;328:521-6. In New York City, the incidence of tuberculosis increased significantly over the past decade, with more than double the number of cases compared to previous years. The study analyzed data from 518 patients with positive tuberculosis cultures in April 1991, finding that 33% had isolates resistant to one or more antituberculosis drugs, 26% to isoniazid, and 19% to both isoniazid and rifampin. Among patients who had previously received treatment, 40% had resistant isolates, and 30% had isolates resistant to both isoniazid and rifampin. Patients infected with HIV or who used injection drugs were more likely to have resistant isolates. Those with resistant isolates were more likely to die, with 80% of HIV-positive patients dying compared to 47% of those without HIV. The study found that previous treatment was the strongest predictor of drug resistance. Patients who had been treated for less than 2 months had a 7% resistance rate, those treated for 2-14 months had 19%, and those treated for more than 14 months had 39%. The case fatality rate was 27% overall, with 26% of previously treated patients and 27% of untreated patients dying. Patients with AIDS were more likely to die, with 80% of those with resistant isolates dying compared to 47% of those without. The study highlights the increasing prevalence of drug-resistant tuberculosis in New York City, with a significant rise in the proportion of patients with resistant isolates. The findings suggest that drug-resistant tuberculosis is a growing public health concern, particularly among previously treated patients, those infected with HIV, and injection drug users. The study recommends measures to control and prevent drug-resistant tuberculosis, including improved treatment adherence and surveillance. The results also emphasize the need for improved public health infrastructure and access to medical care to address the rising incidence of tuberculosis and drug resistance.