Epidemiology and Clinical Characteristics of Pediatric Drug-Resistant Tuberculosis in Chongqing, China

Abstract

To gain insight into the epidemiology of childhood drug resistant tuberculosis (DR-TB) in China that has the second largest burden of TB and the largest number of multidrug resistant (MDR) TB cases in the world, we performed the cross-sectional study to investigate drug resistance of four first-line anti-TB drugs (isoniazid, rifampicin, streptomycin and ethambutol) using Mycobacterium tuberculosis isolates from 196 culture-confirmed pediatric TB cases diagnosed in the Children’s Hospital of Chongqing Medical University, China during 2008–2013. Univariate and multivariate logistic regression analyses were performed to assess the associations between patient demographic and clinical characteristics and DR-and MDR-TB, respectively. Twenty-eight percent (56/196) of the study patients exhibited resistance to at least one of the four first-line anti-TB drugs tested. MDR was found in 4.6% (9/196) of the study patients. More than half (5/9, 55.6%) of the MDR cases were from a single county of Chongqing. A significant association was found between being acid-fast bacilli-smear negative and DR-TB (adjusted OR, 2.33; 95% CI, 1.13–4.80) and between having concurrent thoracic-extrathoracic involvement and MDR-TB (adjusted OR, 9.49; 95% CI, 1.05–85.92), respectively. The findings of this study indicate that the rate of DR is high among pediatric TB patients in Chongqing and suggest an urgent need for studies to identify MDR transmission hotspots in Chongqing, thereby contributing to the control DR- and MDR-TB epidemics in China. The study also generates new insight into the pathogenesis of DR and MDR M. tuberculosis strains and highlights the importance of studying childhood TB to the goal of global TB control.

Epidemiological, Clinical characteristics and Drug resistance situation of Culture-confirmed Children TBM in Southwest of China: A 6-Year Retrospective Study

“…Besides, the drug resistance rate of isoniazid, streptomycin and rifampicin ranked among the first three [2]. This was different from the low rates of isoniazid resistance observed in children in some other parts of China [20,21] and similar to Shaanxi province of China [22]. In our study, children with TBM and MDR-TB accounted for two (4.8) cases; while there was one case with XDR.…”

“…In our study, children with TBM and MDR-TB accounted for two (4.8) cases; while there was one case with XDR. This incidence is relatively lower compared with other regions of China, which may be due to regional differences and the different group of cases in our study [20][21][22]. No significant change was observed in the drug resistance rate of MTB strain against eleven ATDs over 6 years.…”

Epidemiological, Clinical characteristics and Drug resistance situation of Culture-confirmed Children TBM in Southwest of China: A 6-Year Retrospective Study

“…In our study, children with TBM and MDR-TB accounted for 2 (4.8); there was one XDR detected. Compared with other regions of China, this incidence is relatively lower, which may be due to regional differences and the different group of cases in our study [20][21][22]. No significant change was observed in the drug resistance rate of MTB strain against eleven ATDs over 6 years.…”

Multidrug Resistant Tuberculosis in Children in the Democratic Republic of Congo: First Experience With a Short Treatment Course in a University Hospital

“…In China in 2016, Qian Guo et al, in a cross-sectional study of 196 pediatric cases of mycobacterial cultureconfirmed TB, found 44.4% of cases with exclusively thoracic TB, 41.8% of cases with thoracic-extrathoracic TB, and 13.8% of cases with exclusively extrathoracic TB 16 . Extrathoracic TB is more frequently encountered in children than in adults 17 .…”

“…Extrathoracic TB is more frequently encountered in children than in adults 17 . It is important to obtain biological specimens from any suspected anatomic sites for TB from any suspected MDR-TB case, especially in children 16 . The opportunity to examine any biological specimen with Xpert-MTB/Rif can facilitate diagnosis in children who have difficulty in providing sputum for analysis 16 .…”