Epidemiological Trends of Drug-Resistant Tuberculosis in China From 2007 to 2014

Abstract

The emergence and spread of drug-resistant tuberculosis (DR-TB) has become the major concern in global TB control nowadays due to its limited therapy options and high mortality. A comprehensive evaluation for the epidemiological trends of DR-TB in mainland China, of which TB incidences remain high, is essential but lacking. This study aimed to describe the trends of DR-TB overtime, especially multidrug-resistant TB (MDR-TB); and to identify unique characteristics of MDR-TB cases compared with drug-susceptible TB cases in Mainland China.We retrospectively analyzed surveillance data collected from 36 TB prevention and control institutions in Shandong Province, China over an 8-year period. Unique characteristics of MDR-TB were identified; Chi-square test for trends and linear regression were used to assess the changes in proportions of different resistance patterns overtime.The overall MDR rate was 6.2% in our sample population. There were no statistically significant changes in the percentage of drug-susceptible, isoniazid (INH) resistance, ethambutol (EMB) resistance, streptomycin (SM) resistance, and MDR TB during our study period except that the overall rifampin (RFP) resistance and rifampin monoresistance (RMR) increased at a yearly rate of 0.2% and 0.1%, respectively. Among those with known treatment histories, a higher MDR rate of 8.7% was observed, in which 53.9% were primary MDR-TB patients, and this rate was increasing at a yearly rate of 4.1% over our study period. MDR-TB patients were more likely to be female (odds ratio [OR], 1.23; 95% confidence interval [CI], 1.05–1.34), aged 25 to 44 years (OR, 1.67; 95%CI, 1.45–1.93), retreated (OR, 11.95; 95%CI, 9.68–14.76), having prior TB contact (OR, 1.89; 95%CI, 1.19–2.78) and having cavity (OR, 1.57; 95%CI 1.36–1.81), or bilateral disease (OR, 1.45; 95%CI 1.19–1.76) on chest radiology.Persistent high levels of MDR-TB, increasing rates of primary MDR-TB and RMR characterize DR-TB cases in mainland China; community-acquired drug resistance may be one of the most modifiable factors in future TB control strategies.

Survey of Drug-Resistant Tuberculosis Patients in a University Tertiary Hospital in Saudi Arabia

“…Th e rate of MDR-TB in our study was 4.3%, which is similar to the 5% global rate established by the WHO report in 2015 [19] . In our study, 11.7% of patients were previously treated for TB, which is similar to that observed in China and India (11% and 12%, respectively) [20][21] . All of the MDR-TB cases also reported having close contact with other TB patients, indicating that close contact with other TB patients is a risk factor for developing DR-TB, which has been confi rmed previously [21] .…”

“…In our study, 11.7% of patients were previously treated for TB, which is similar to that observed in China and India (11% and 12%, respectively) [20][21] . All of the MDR-TB cases also reported having close contact with other TB patients, indicating that close contact with other TB patients is a risk factor for developing DR-TB, which has been confi rmed previously [21] . Moreover, the incidence of HIV infection in cases of DR-TB was higher than that observed in the 2013 national survey (5% vs. 1%).…”

Resistance Ratios of Mycobacterium tuberculosis Complex Strains Isolated in Erzurum Regional Tuberculosis Laboratory Against Major Antituberculosis Drugs

“…Dünyadaki değişik ülkelerde yapılmış çalışmalarda da farklı sonuçlar ortaya çıkmıştır. Çin'de yapı-lan ve 2007-2014 yıllarını kapsayan geniş katılımlı bir araştırmada ÇİD-MTK oranı % 6.2 bulunmuştur (9) . Endonezya'da Lisdawati ve ark.…”

Multidrug-Resistant Tuberculosis (MDR-TB): Epidemiology, Causes, Pathophysiology, Diagnostic Approaches, Preventive Interventions, and Treatment Challenges/Opportunities – (An Evidence-Based Narrative Literature Review)

“…The absence of ventilation and overcrowding also elevates the prevalence of MDR-TB among high-risk patients. The individuals having known clinical history of TB exhibit an elevated predisposition towards the development of rifampicin resistance that eventually leads to the progression of MDR-Tb and associated comorbidities [10]. Therefore, epidemiology-based findings of the presented study as well as evidence-based clinical literature substantiate the requirement of MDR-TB drugs' susceptibility testing for the predisposed patients to facilitate the timely administration of the appropriate pharmacotherapy [8].…”