Factors contributing to the high prevalence of multidrug-resistant tuberculosis: a study from China

Abstract

BackgroundThe rapid spread of multidrug-resistant tuberculosis (MDR-TB) has attracted global concerns. This study aimed to identify factors contributing to the high prevalence of MDR-TB in China's Heilongjiang province. Methods A cross-sectional survey following the WHO/ International Union Against Tuberculosis and Lung Disease guidelines was conducted with consecutive recruitment of patients with TB in 30 counties selected at random in Heilongjiang in 2004. A total of 1995 patients were tested for MDR-TB. Factors associated with MDR-TB were identified through multilevel models and traditional logistic regression analysis, along with in-depth interviews with nine patients, five healthcare managers and four doctors. Results 241 patients (12%) were identified with MDR-TB. The retreatment patients were 5.48 times (95% CI 4.04 to 7.44) more likely to have MDR-TB than newly diagnosed patients. The patients who were treated with isoniazid and rifampin for >180 days were 4.82 times (95% CI 2.97 to 7.81) more likely to develop MDR-TB than those treated <180 days. Age and delay in initiating TB treatment were associated with MDR-TB. Financial burden, poor knowledge and side effects of TB treatment were perceived by the interviewees as influencing factors. Lack of coordination of services, unsatisfactory supervision of treatment and infection control jeopardised the control of MDR-TB. Conclusions Inappropriate treatment is the most important influencing factor of MDR-TB. Increasing people's awareness of TB, early detection and appropriate treatment of patients with TB should become a priority, which requires strong commitment and collaboration among health organisations and greater compliance with TB treatment guidelines by service providers and patients.

Drug resistance pattern, related socio- demographic factors and preventive practices among MDR-TB patients: An experience from a tertiary care setting

“…In Ethiopia, Abate G 16 Showed MDR prevalence were more in retreatment cases (12%) than new (1.2%). In A study shown by Liang et al 17 in China , inappropriate treatment, longer delays to effective therapy were the most influential factors behind emergence of drug resistance. Retreatment patients were 5.48 times and those with previous INH and RMP therapy for more than 180 days were 4.82 times more likely to develop MDR-TB.…”

Previous Treatment Failure or Default Increased the Risk of Massive Hemoptysis in PTB Patients

“…Those who had a failure or default treatment were more likely to get massive hemoptysis. Liang L et al reported that the top three reasons for failure to complete the TB treatment regimens in China were poor knowledge, financial burden and treatment side effects [7]. Poor knowledge about TB and mild symptoms，many patients tended to delay initiating treatment, prolong the time that patients carry the TB bacteria and allow the disease to progress without proper intervention.…”

Mycobacterium Strain and Type of Resistance in Pulmonary Tuberculosis Patients: A Missed Link in Iran’s National Tuberculosis Plan

“…Multidrug Resistant Tuberculosis (MDR-TB), is caused by mycobactria isolates which are resistant to, at least, Isoniazid (INH) and, Rifampin (RIF) (5,6). Delayed diagnosis and inappropriate treatment of tuberculosis may result in constantly increasing severity, mortality, spreading and the emergence of MDR-TB (7)(8)(9). Annually, MDR-TB is estimated to afflict 490,000 cases, or 5% of the global TB burden.…”