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Epidemiology of anti-tuberculosis drug resistance in a Chinese population: current situation and challenges ahead.

Shao Y, Yang D, Xu W, Lu W, Song H, Dai Y, Shen H, Wang J - BMC Public Health (2011)

Bottom Line: The prevalence of MDR-TB was 16.61%, which was significantly different between new cases (7.63%) and those with previous treatment history (33.07%).The age of patients was significantly associated with the risk of drug resistance (P < 0.001) and the adjusted OR (95% CI) was 1.88(1.26-2.81) for patients aged 35-44 years when compared with those 65 years or older.Patients with previous treatment history had a more than 5-fold increased risk of MDR-TB (adjusted OR: 6.14, 95% CI: 4.61-8.17), compared with those previously not having been treated.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Chronic Infectious Diseases, Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, PR China.

ABSTRACT

Background: Drug resistance has been a cause of concern for tuberculosis (TB) control in both developed and developing countries. Careful monitoring of the patterns and trends of drug resistance should remain a priority.

Methods: Strains were collected from 1824 diagnosed sputum smear positive pulmonary TB patients in Jiangsu province of China and then tested for drug susceptibility against rifampicin, isoniazid, ethambutol and streptomycin. The prevalence and patterns of drug resistance in mycobacterium tuberculosis (MTB) isolates were investigated. Multiple logistic regression analysis was performed to identify the risk factors for multidrug resistant (MDR) bacterial infection. The strength of association was estimated by odds ratio (OR) and 95% confidence interval (95% CI).

Results: The drug susceptibility tests showed that 1077(59.05%) MTB strains were sensitive to all the four antibiotics and the other 747(40.95%) strains were resistant to at least one drug. The proportions of mono-drug resistance were 28.73% for isoniazid, 19.41% for rifampicin, 29.33% for streptomycin, and 13.98% for ethambutol, respectively. The prevalence of MDR-TB was 16.61%, which was significantly different between new cases (7.63%) and those with previous treatment history (33.07%). Geographical variation of drug resistance was observed, where the proportion of MDR-TB among new cases was higher in the central (9.50%) or north part (9.57%) than that in the south area (4.91%) of Jiangsu province. The age of patients was significantly associated with the risk of drug resistance (P < 0.001) and the adjusted OR (95% CI) was 1.88(1.26-2.81) for patients aged 35-44 years when compared with those 65 years or older. Patients with previous treatment history had a more than 5-fold increased risk of MDR-TB (adjusted OR: 6.14, 95% CI: 4.61-8.17), compared with those previously not having been treated.

Conclusions: The high prevalence of drug resistance has been a major challenge for TB control. Prevention and control of drug-resistant TB should be emphasized by the revised DOTS (direct observed therapy, short course) program through prompt case detection, routine and quality-assured drug susceptibility test for patients at high risk of resistance, programmatic treatment with both first and second-line medicines, and systematic treatment observation, with priority for high MDR-TB settings.

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Geographical variation of MDR-TB in Jiangsu province. The study sites were categorized as three groups (north, central and south) based on their locations. MDR: resistant to at least isoniazid and rifampicin.
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Figure 3: Geographical variation of MDR-TB in Jiangsu province. The study sites were categorized as three groups (north, central and south) based on their locations. MDR: resistant to at least isoniazid and rifampicin.

Mentions: Among 1940 sputum smear positive TB patients recruited in the study, 1848 (95.26%) cases were positively cultured, 63 (3.25%) cases were negatively cultured, and 29 (1.49%) cases were contaminated. After excluding 24 cases infected with non-tuberculosis mycobacterium, 1824 cases determined as MTB were involved in the final analysis (Figure 1). Most of them (97.81%) were Han Chinese. The nationalities of remaining patients included Hui, Mongolian, Miao, Yi, Zhuang, Tu, Buyi, Bai, and Hani etc. The average age was 50.8 ± 19.3 years and the sex ratio was 2.7 with 1340 (73.46%) men and 484 (26.54%) women. Among them, 1180 (64.69%) were new cases and 644 (35.31%) were those previously treated. The DST results showed that 1077 (59.05%) strains were sensitive to all first-line antibiotics tested in our study and 747 (40.95%) were resistant to at least one drug. The proportions of mono-drug resistance were 28.73% for INH, 19.41% for RIF, 29.33% for SM, and 13.98% for EMB, respectively (Table 1). Individual or combined drug resistance to INH, RIF, EMB and SM was higher in previously treated cases than that in new cases. The details of multi-drug resistance are presented in Table 2. Among all isolates, 303(16.61%) strains were resistant to both INH and RIF (MDR-TB), and 146(8.00%) strains were resistant to all four first-line anti-tuberculosis drugs (Table 2, Figure 2). The proportion of MDR-TB was 33.07% in previously treated cases, which was significantly higher than that (7.63%) in new cases (χ2 = 194.76, P < 0.001) (Table 2, Figure 2). We further divided the study sites into three groups (south, central and north) based on their locations in Jiangsu and found the geographical variation of MDR-TB risk estimates. The proportions of MDR were 13.23% in south, 18.37% in central and 19.00% in north area of Jiangsu, respectively (Table 3). The geographical difference was statistically significant among new cases (Figure 3). As shown in table 3, a higher proportion of MDR-TB in new cases was observed in the central or north part but not in the south area. The percentage of MDR-TB grouped by age was illustrated in Figure 4. The frequency of MDR-TB was much higher in young adults and peaked at 35-44 years old. Compared with patients aged 65 years or older, the adjusted OR (95% CI) was 1.88(1.26-2.81) for those aged 35-44 years.


Epidemiology of anti-tuberculosis drug resistance in a Chinese population: current situation and challenges ahead.

Shao Y, Yang D, Xu W, Lu W, Song H, Dai Y, Shen H, Wang J - BMC Public Health (2011)

Geographical variation of MDR-TB in Jiangsu province. The study sites were categorized as three groups (north, central and south) based on their locations. MDR: resistant to at least isoniazid and rifampicin.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3045946&req=5

Figure 3: Geographical variation of MDR-TB in Jiangsu province. The study sites were categorized as three groups (north, central and south) based on their locations. MDR: resistant to at least isoniazid and rifampicin.
Mentions: Among 1940 sputum smear positive TB patients recruited in the study, 1848 (95.26%) cases were positively cultured, 63 (3.25%) cases were negatively cultured, and 29 (1.49%) cases were contaminated. After excluding 24 cases infected with non-tuberculosis mycobacterium, 1824 cases determined as MTB were involved in the final analysis (Figure 1). Most of them (97.81%) were Han Chinese. The nationalities of remaining patients included Hui, Mongolian, Miao, Yi, Zhuang, Tu, Buyi, Bai, and Hani etc. The average age was 50.8 ± 19.3 years and the sex ratio was 2.7 with 1340 (73.46%) men and 484 (26.54%) women. Among them, 1180 (64.69%) were new cases and 644 (35.31%) were those previously treated. The DST results showed that 1077 (59.05%) strains were sensitive to all first-line antibiotics tested in our study and 747 (40.95%) were resistant to at least one drug. The proportions of mono-drug resistance were 28.73% for INH, 19.41% for RIF, 29.33% for SM, and 13.98% for EMB, respectively (Table 1). Individual or combined drug resistance to INH, RIF, EMB and SM was higher in previously treated cases than that in new cases. The details of multi-drug resistance are presented in Table 2. Among all isolates, 303(16.61%) strains were resistant to both INH and RIF (MDR-TB), and 146(8.00%) strains were resistant to all four first-line anti-tuberculosis drugs (Table 2, Figure 2). The proportion of MDR-TB was 33.07% in previously treated cases, which was significantly higher than that (7.63%) in new cases (χ2 = 194.76, P < 0.001) (Table 2, Figure 2). We further divided the study sites into three groups (south, central and north) based on their locations in Jiangsu and found the geographical variation of MDR-TB risk estimates. The proportions of MDR were 13.23% in south, 18.37% in central and 19.00% in north area of Jiangsu, respectively (Table 3). The geographical difference was statistically significant among new cases (Figure 3). As shown in table 3, a higher proportion of MDR-TB in new cases was observed in the central or north part but not in the south area. The percentage of MDR-TB grouped by age was illustrated in Figure 4. The frequency of MDR-TB was much higher in young adults and peaked at 35-44 years old. Compared with patients aged 65 years or older, the adjusted OR (95% CI) was 1.88(1.26-2.81) for those aged 35-44 years.

Bottom Line: The prevalence of MDR-TB was 16.61%, which was significantly different between new cases (7.63%) and those with previous treatment history (33.07%).The age of patients was significantly associated with the risk of drug resistance (P < 0.001) and the adjusted OR (95% CI) was 1.88(1.26-2.81) for patients aged 35-44 years when compared with those 65 years or older.Patients with previous treatment history had a more than 5-fold increased risk of MDR-TB (adjusted OR: 6.14, 95% CI: 4.61-8.17), compared with those previously not having been treated.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Chronic Infectious Diseases, Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, PR China.

ABSTRACT

Background: Drug resistance has been a cause of concern for tuberculosis (TB) control in both developed and developing countries. Careful monitoring of the patterns and trends of drug resistance should remain a priority.

Methods: Strains were collected from 1824 diagnosed sputum smear positive pulmonary TB patients in Jiangsu province of China and then tested for drug susceptibility against rifampicin, isoniazid, ethambutol and streptomycin. The prevalence and patterns of drug resistance in mycobacterium tuberculosis (MTB) isolates were investigated. Multiple logistic regression analysis was performed to identify the risk factors for multidrug resistant (MDR) bacterial infection. The strength of association was estimated by odds ratio (OR) and 95% confidence interval (95% CI).

Results: The drug susceptibility tests showed that 1077(59.05%) MTB strains were sensitive to all the four antibiotics and the other 747(40.95%) strains were resistant to at least one drug. The proportions of mono-drug resistance were 28.73% for isoniazid, 19.41% for rifampicin, 29.33% for streptomycin, and 13.98% for ethambutol, respectively. The prevalence of MDR-TB was 16.61%, which was significantly different between new cases (7.63%) and those with previous treatment history (33.07%). Geographical variation of drug resistance was observed, where the proportion of MDR-TB among new cases was higher in the central (9.50%) or north part (9.57%) than that in the south area (4.91%) of Jiangsu province. The age of patients was significantly associated with the risk of drug resistance (P < 0.001) and the adjusted OR (95% CI) was 1.88(1.26-2.81) for patients aged 35-44 years when compared with those 65 years or older. Patients with previous treatment history had a more than 5-fold increased risk of MDR-TB (adjusted OR: 6.14, 95% CI: 4.61-8.17), compared with those previously not having been treated.

Conclusions: The high prevalence of drug resistance has been a major challenge for TB control. Prevention and control of drug-resistant TB should be emphasized by the revised DOTS (direct observed therapy, short course) program through prompt case detection, routine and quality-assured drug susceptibility test for patients at high risk of resistance, programmatic treatment with both first and second-line medicines, and systematic treatment observation, with priority for high MDR-TB settings.

Show MeSH
Related in: MedlinePlus