Multidrug-resistant tuberculosis (MDR-TB) disease burden in China: a systematic review and spatio-temporal analysis

Ding, Peipei; Li, Xiaowen; Jia, Zhongwei; Lü, Zeng

doi:10.1186/s12879-016-2151-5

Cited by 48 publications

(47 citation statements)

References 14 publications

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Section: Discussioncontrasting

confidence: 77%

“…The proportion of MDR-TB cases in the present study was 5% in Prefecture E and 10% in Prefecture W, which was lower than the proportion of incident MDR-TB cases in China (12%) based on a previous meta-analysis [19]. Meanwhile, a substantial spatial difference in the MDR-TB burden between Prefecture E and Prefecture W was observed in the current study, which was consistent with recent systematic reviews [19,20]. The difference in the prevalence of culture-positive TB and MDR-TB amongst diagnosed TB patients between the eastern and western sites might be due to social economic status, educational level, population density and mobility, proportion of ethnic minorities, and distribution of relevant diseases based on geographic features.…”

Section: Discussioncontrasting

confidence: 77%

See 1 more Smart Citation

High-risk screening and detection of multidrug-resistant tuberculosis in two prefectures of China: a drug susceptibility surveillance-based secondary data analysis

Yang

Zhou

Ning

et al. 2018

Global Health Action

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Background: In China, less than one-fifth of multidrug-resistant tuberculosis (MDR-TB) cases are detected. MDR-TB screening is conducted amongst the following five high-risk groups of TB patients: chronic cases, close contacts of MDR-TB patients, patients with treatment failure, relapsed and returned patients, and smear-positive patients at the end of the third month of initial treatment. Objective: To estimate the possibility of detecting MDR-TB cases if only the high-risk screening strategy is applied in China. Methods: A secondary analysis was applied to the surveillance-based longitudinal data of all sputum smear-positive TB patients in Prefecture E and Prefecture W of China from 2013 to 2015. The population attributable risk (PAR) was estimated using odds ratios for five risk factors/predictors and exposure proportions amongst all MDR-TB cases. Results: A total of 3513 TB patients (2807 from Prefecture E and 706 from Prefecture W) were included. Males accounted for 77.91% (2737/3513) of the patients. The average age was 52.5 ± 20.0 years old. Overall, 40.34% (71/176) of MDR-TB patients were from the five high-risk groups during the three-year study period. The detected proportion of MDR-TB cases using the high-risk screening strategy was significantly higher in Prefecture E than in Prefecture W. The PAR% for all five risk factors/predictors was 43.4% (95% CI: 24.6–61.7%), 49.9% (95% CI: 31.3–67.0%), and 30.3% (95% CI: 12.9–50.1%) in Prefecture E and 36.6% (95% CI: 10.4–64.5%), 13.3% (95% CI: −1.7–39.7%), and −82.5% (95% CI: −117.5–−11.2%) in Prefecture W in 2013, 2014, and 2015, respectively. The PAR% for the five specific risk factors/predictors ranged from 0.4% (95% CI: −0.2–4.8%) to 21.0% (95% CI: 13.1–30.0%) in these two prefectures. Conclusion: In general, a high-risk screening strategy would miss more than half of the MDR-TB patients because they do not belong to the five high-risk groups.

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Section: Discussioncontrasting

confidence: 77%

Section: Discussioncontrasting

confidence: 77%

High-risk screening and detection of multidrug-resistant tuberculosis in two prefectures of China: a drug susceptibility surveillance-based secondary data analysis

Yang

Zhou

Ning

et al. 2018

Global Health Action

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“…The average annual TB incidence rate in Hunan Province was 78.9 per 100,000 population during the period 2005–2009 [ 11 ]. The proportions of MDR- and XDR-TB among all TB patients were 10.6–25.2% and 1.8% [ 12 , 13 ], higher than the national proportions [ 6 ].…”

Section: Methodsmentioning

confidence: 99%

Treatment outcomes of patients with multidrug-resistant and extensively drug resistant tuberculosis in Hunan Province, China

Alene

Viney

et al. 2017

BMC Infect Dis

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BackgroundThe worldwide emergence of multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) has posed additional challenges for global tuberculosis (TB) control efforts, as limited treatment options are available and treatment outcomes are often sub-optimal. This study determined treatment outcomes among a cohort of MDR-TB and XDR-TB patients in Hunan Province, China, and identified factors associated with poor treatment outcomes.MethodsWe conducted a retrospective study using data obtained from medical records of TB patients in Hunan Chest Hospital, and from the internet-based TB management information system managed by the Tuberculosis Control Institute of Hunan Province, for the period 2011 to 2014. Treatment outcomes were assessed for patients diagnosed with MDR-TB (TB resistant to at least isoniazid and rifampicin) and XDR-TB (MDR-TB plus resistance to any fluoroquinolone and at least 1 second-line injectable drug). Cumulative incidence functions were used to estimate time to events (i.e. poor treatment outcomes, loss to follow-up, and unfavourable treatment outcomes); and a competing-risks survival regression model was used to identify predictors of treatment outcomes.ResultOf 481 bacteriologically-confirmed patients, with a mean age of 40 years (standard deviation SD ± 13 years), 10 (2%) had XDR-TB and the remainder (471; 98%) had MDR-TB. For the entire cohort, treatment success was 57% (n = 275); 58% (n = 272) for MDR-TB and 30% (n = 3) for XDR-TB. Overall, 27% were lost to follow-up (n = 130), 27% (n = 126) for MDR-TB and 40% (n = 4) for XDR-TB; and 16% had a poor treatment outcome (n = 76), 15% for MDR-TB and 30% (n = 3) for XDR-TB. Of the 10 XDR-TB patients, 3 (30%) completed treatment, 3 (30%) died and 4 (40%) were lost to follow-up. Of the 471 MDR-TB patients, 258 (57%) were cured, 16 (3%) completed treatment, 13 (3%) died, 60 (13%) experienced treatment failure, and 126 (27%) were lost to follow-up. Resistance to ofloxacin was an independent predictor of poor (AHR = 3.1; 95%CI = 1.5, 6.3), and unfavourable (AHR = 1.7; 95%CI = 1.07, 2.9) treatment outcomes. Patients who started treatment during 2011–2012 (AHR = 2.8; 95% CI = 1.5, 5.3) and 2013 (AHR = 2.1; 95% CI = 1.2, 3.9) had poorer treatment outcomes compared to patients who started treatment during 2014.ConclusionPatients with MDR-TB and XDR-TB had low rates of treatment success in Hunan Province, especially among patients who started treatment during 2011 to 2013, with evidence of improved treatment outcomes in 2014. Resistance to ofloxacin was an independent predictor of poor treatment outcomes.

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“…During the past few decades, great effort has been made to control the spread of TB in China. However, drug resistant tuberculosis (DR-TB) is becoming more serious [4].The latest global TB report 2018 pointed out that the number of new TB patients in China reached 889 000, of which DR-TB accounted for 7.1% [3]. Multi-drug resistant tuberculosis (MDR-TB) is resistant to most first-line anti-TB drugs, the current standard chemotherapy regimen is not effective, and the disease gradually develops into refractory, recurrent TB, which seriously affects the prognosis.…”

Section: Introductionmentioning

confidence: 99%

Multi-drug resistant spinal tuberculosis-epidemiological characteristics of in-patients: a multicentre retrospective study

Yang

et al. 2020

Epidemiol. Infect.

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Tuberculosis (TB) is the leading cause of death among infectious diseases. China has a high burden of TB and accounted for almost 13% of the world's cases of multi-drug resistant (MDR) TB. Spinal TB is one reason for the resurgence of TB in China. Few large case studies of MDR spinal TB in China have been conducted. The aim of this research was to observe the epidemiological characteristics of inpatients with MDR spinal TB in six provinces and cities of China from 1999–2015. This is a multicentre retrospective observational study. Patients' information was collected from the control disease centre and infectious disease database of hospitals in six provinces and cities in China. A total of 3137 patients with spinal TB and 272 patients with MDR spinal TB were analysed. The result showed that MDR spinal TB remains a public health concern and commonly affects patients 15–30 years of age (34.19%). The most common lesions involved the thoracolumbar spine (35.66%). Local pain was the most common symptom (98.53%). Logistic analysis showed that for spinal TB patients, reside in rural district (OR 1.79), advanced in years (OR 1.92) and high education degree (OR 2.22) were independent risk factors for the development of MDR spinal TB. Women were associated with a lower risk of MDR spinal TB (OR 0.48). The most common first-line and second-line resistant drug was isoniazid (68.75%) and levofloxacin (29.04%), respectively. The use of molecular diagnosis resulted in noteworthy clinical advances, including earlier initiation of MDR spinal TB treatment, improved infection control and better clinical outcome. Chemotherapy and surgery can yield satisfactory outcomes with timely diagnosis and long-term treatment. These results enable a better understanding of the MDR spinal TB in China among the general public.

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Multidrug-resistant tuberculosis (MDR-TB) disease burden in China: a systematic review and spatio-temporal analysis

Cited by 48 publications

References 14 publications

High-risk screening and detection of multidrug-resistant tuberculosis in two prefectures of China: a drug susceptibility surveillance-based secondary data analysis

High-risk screening and detection of multidrug-resistant tuberculosis in two prefectures of China: a drug susceptibility surveillance-based secondary data analysis

Treatment outcomes of patients with multidrug-resistant and extensively drug resistant tuberculosis in Hunan Province, China

Multi-drug resistant spinal tuberculosis-epidemiological characteristics of in-patients: a multicentre retrospective study

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