Drug resistance characteristics of Mycobacterium tuberculosis isolates between 2014 and 2017 in Sichuan, China: A retrospective study

Abstract

BackgroundThe prevalence of drug-resistant tuberculosis (DR-TB) has brought severe challenges to the prevention and control of tuberculosis. Studies have explored the status of antituberculosis drug (ATD) resistance in different regions of China. However, few studies have focused on DR-TB in Sichuan to date. Due to the large population in Sichuan, detailed investigations of the DR-TB burden in Sichuan are needed. The objective of this study was to investigate the drug resistance characteristics of TB isolates from tuberculosis patients with and without HIV (TB-HIV patients and TBw/oHIV patients) in Chengdu, Sichuan, China.MethodsIsolates from respiratory samples of TBw/oHIV patients and TB-HIV patients hospitalized between January 2014 and December 2017 were collected. Nontuberculosis mycobacteria (NTM) were excluded. Drug sensitivity testing (DST) was performed according to the dilution method in microplates with 4 first-line ATDs and 8 second-line ATDs. TB strains were separated according to patient treatment history, patient age, calendar year and GeneXpert MTB/RIF (GeneXpert) assay results for further analysis.ResultsFor the 7470 patients recruited, the multidrug-resistant tuberculosis (MDR-TB) rate was 2.1-fold (14.6% vs. 6.8%) higher than the national baseline level. The repeatedly admitted patients were more likely to have a resistance profile than the first-time-admitted cases in both the TB-only group (P<0.05) and the TB-HIV corresponding group (P<0.05). Among the 7273 TBw/oHIV cases and 197 TB-HIV cases, the positivity rates of acid-fast bacilli (AFB) in the TB-HIV group were significantly lower than those in the TBw/oHIV group (P<0.05). The repeatedly admitted TB-HIV patients had lower resistance rates to INH than the repeatedly admitted TBw/oHIV patients (24.4% vs. 41.5%, P<0.05). The Rifampicin-resistant TB strains in the TBw/oHIV group were more likely to be resistant to INH in the repeatedly admitted group than those in the first-time admitted patients (P<0.05). The proportions of XDR (3.6% vs. 1.3%, P<0.05) and XDR-TB/MDR-TB (7.3% vs. 2.2%, P<0.05) in all TB-HIV patients were significantly higher than those in all TBw/oHIV patients. The ratio of XDR-TB was significantly higher in the TB-HIV group than in the TBw/oHIV group (30.4% vs. 9.0%, P<0.05) and the all TB group (9.0% vs. 10.1%, P<0.05). Regarding age, the <25-year-old TB-HIV patients (9.1% vs. 0.7%, P<0.05) and 25~44-year-old TB-HIV patients (5.2% vs. 2.4%, P<0.05) were more likely to have a higher XDR proportion than their TBw/oHIV counterparts. The ATD-resistance profile in terms of different years from high to low was 2014>2015>2016≈2017 for TBw/oHIV patients. The same trend was also observed for TB-HIV patients: 2014>2015>2016≈2017. The GeneXpert TB-positive rate in the TBw/oHIV group was higher than that in the TB-HIV group [81%(639/792) vs. 65% (13/20), P<0.05]. In TBw/oHIV cases, the agreement was 92.3% and the Kappa value was 0.75. In TB-HIV cases, the agreement was 85.0% and the Kappa value was 0.32.ConclusionIn Sichuan, ATD resista...

Mycobacterium culturing and drug resistance of osteoarticular tuberculosis in Xinjiang, China

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Drug Resistance Characteristics of Mycobacterium tuberculosis Isolates From Patients With Tuberculosis to 12 Antituberculous Drugs in China

“…The critical concentration of Mycobacterium tuberculosis drug sensitivity test is based on CLSI M24-A2 and FDA-approved standards for drug susceptibility testing. Among them, the critical concentration of cycloserine is derived from the FDA-approved standards (https://www.accessdata.fda.gov/spl/data/a0f29de7-d7cd-45a0-915a-eae2562edaf8/a0f29de7-d7cd-45a0-915a-eae2562edaf8.xml), and the rest are from CLSI M24-A2 (Woods et al, 2011; Zhou et al, 2018).…”

“…In China, there were an estimated 7.1% of initial treated TB cases with MDR/RR-TB and an estimated 14% of re-treated TB cases with MDR/RR-TB (World Health Organization, 2018). The prevalence of MDR-TB varied from region to region, 14.3% in Guizhou (Lan et al, 2019), 8.0% in Hangzhou (Li et al, 2018), 13.3% in Sichuan (Zhou et al, 2018), 13.2% in Hebei (Li et al, 2016), 9% in Beijing (Liu et al, 2018), and 5% in Shanghai (Yang et al, 2017).…”