The epidemiological characteristics and profile of drug-resistant tuberculosis among children with tuberculosis in Sichuan, China, 2015–2018

Xu, Yuanhong; Li, Qingfeng; Zhu, Minmin; Wu, Xueqi; Wang, Dongmei; Luo, Jia; Li, Yingjie; Zhong, Jing; Zeng, Peibin

doi:10.1097/md.0000000000022608

Cited by 6 publications

(5 citation statements)

References 22 publications

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“…Previous studies have indicated that BCG vaccination could decrease the risk of severe TB. 45 In our study, the distribution of BCG vaccination was different in the MDR and DS groups, and BCG vaccination was a protective factor against MDR-TB in children. However, this result might be caused by 100% of patients in the MDR group having severe TB.…”

Section: Discussionmentioning

confidence: 51%

Analysis of Factors Influencing Multidrug-Resistant Tuberculosis and Validation of Whole-Genome Sequencing in Children with Drug-Resistant Tuberculosis

Zhang¹,

Zhao²,

Zhang³

et al. 2021

IDR

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Objective Pediatric tuberculosis (TB) is one of the top ten causes of death in children. Our study was to analyze influencing factors of multidrug-resistant tuberculosis (MDR-TB) and validation of whole-genome sequencing (WGS) used in children with drug-resistant TB (DR-TB). Methods All Mycobacterium tuberculosis (Mtb) strains were isolated from patients aged below 18 years old of Children’s Hospital of Chongqing Medical University, China. A total of 208 Mtb isolates were tested for eight anti-TB drugs with phenotypic drug susceptibility test (DST) and for genetic prediction of the susceptible profile with WGS. The patients corresponding to each strain were grouped according to drug resistance and genotype. Influencing factors of MDR-TB and DR-TB were analyzed. Results According to the phenotypic DST and WGS, 82.2% of Mtb strains were susceptible to all eight drugs, and 6.3% were MDR-TB. Using the phenotypic DSTs as the gold standard, the kappa value of WGS to predict isoniazid, rifampin, ethambutol, rifapentine, prothionamide, levofloxacin, moxifloxacin and amikacin was 0.84, 0.89, 0.59, 0.86, 0.89, 0.82, 0.88 and 1.00, respectively. There was significant difference in the distribution of severe TB, diagnosis, treatment and outcome between MDR and drug-susceptible group (P<0.05). The distribution of severe TB and treatment between DR and drug-susceptible group was statistically different (P<0.05). The results of binary logistic regression showed that Calmette–Guérin bacillus (BCG) vaccine is the protective factor for MDR-TB (OR=0.19), and MDR-TB is the risk factor for PTB and EPTB (OR=17.98). Conclusion The BCG vaccine is a protective factor for MDR-TB, and MDR-TB might not be confined to pulmonary infection, spreading to extrapulmonary organs in children. MDR-TB had more severe cases and a lower recovery rate than drug-susceptible TB. WGS could provide an accurate prediction of drug susceptibility test results for anti-TB drugs, which are needed for the diagnosis and precise treatment of TB in children.

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Section: Discussionmentioning

confidence: 51%

Analysis of Factors Influencing Multidrug-Resistant Tuberculosis and Validation of Whole-Genome Sequencing in Children with Drug-Resistant Tuberculosis

Zhang¹,

Zhao²,

Zhang³

et al. 2021

IDR

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“…[ 26 ] In recent years, the multi-drug resistance rates of DR-TB in children reported in various parts of China have been lower than the reporting level from 2005 to 2012. [ 5 , 8 , 17 ] The results of this study also showed that the DR resistance rate in Sichuan decreased in the past 5 years, indicating that the normal treatment for tuberculosis in children in the past 5 years showed a good therapeutic effect, but also reflected the importance of prevention and control in children. However, there was no significant downward trend in the rate of multi-drug resistance in the past 5 years, and it is necessary to further strengthen the understanding of actively carrying out drug resistance examination in newly diagnosed children, timely develop standardized drug resistance regimens, and improve the cure rate.…”

Section: Discussionmentioning

confidence: 56%

“…[ 7 ] A retrospective study on the epidemiological characteristics and characteristics of DR-TB in children with tuberculosis in Sichuan Province from 2015 to 2018 showed that the culture-confirmed tuberculosis in children accounted for 3% of all new tuberculosis cases, which was lower than the estimated proportion of tuberculosis in children in China, with the overall rate of DR-TB at 24.3% and the rate of MDR-TB at 5.4%. [ 8 ] The analysis by Zignol et al [ 9 ] found that the risk of MDR-TB was similar in children between under 5 years and 5 to 14 years of age. It is important to pay attention to the diagnosis and prevention of tuberculosis and drug resistance in children for disease control.…”

Section: Introductionmentioning

confidence: 99%

Trends and risk factors for drug-resistant tuberculosis among children in Sichuan, China: A 10-year retrospective analysis, 2013–2022

Li,

Deng,

Huang

et al. 2024

Medicine

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To investigate the status of the drug-resistant tuberculosis (DR-TB) among children in Sichuan, and to find out the risk factors and high-risk population related to drug resistance among children. The clinical data of tuberculosis patients ≤14 years old with culture-confirmed tuberculosis hospitalized in Chengdu Public Health Clinical Center from January 2013 through December 2022 were collected. Clinical data such as gender, age, ethnicity, history of anti-TB treatment, history of exposure to tuberculosis, nutritional status, and specific drug resistance of the children were collected and recorded. The drug resistance of children in different age groups (0–4 years old, 5–9 years old, 10–14 years old) and different periods (2013–2017 and 2018–2022) were grouped and compared. Logistic regression analysis was to analyze analysis of risk factors of drug resistance in children. A total of 438 children with culture-confirmed tuberculosis were screened. Among them, 26.19% (11/42) were 0 to 4 years old, 33.33% (22/66) were 5 to 9 years old, and 36.67% (121/330) were 10 to 14 years old among the resistant children. There was no statistically significant difference in the resistance rate among the 3 groups (P = .385). The proportions of DR-TB, monoresistant tuberculosis, polydrug-resistant tuberculosis were decreased during 2019 to 2022 compared with 2013 to 2017 (P < .0001). The resistance rates of drug resistant, monoresistant, polydrug-resistant, isoniazid-resistant, and rifampicin resistant during 2018 to 2022 were decreased compared with those from 2013 to 2017 (P < .05), but the multi-drug resistance rate was not decreased (P = .131, without statistical difference). The results of logistic regression analysis showed that male gender OR = 1.566 (95% CI 1.035–2.369), a history of antituberculosis therapy OR = 4.049 (95% CI 1.442–11.367), and pulmonary and extrapulmonary tuberculosis OR = 7.335 (95% CI 1.401–38.392) were risk factors for the development of drug resistance; but fever OR = 0.581 (95% CI 0.355–0.950) was Protective factor. The total drug resistance rate of children in Sichuan showed a downward trend, but the rate of multi-drug-resistant tuberculosis was still at a high level, and the form of drug resistance was still severe. Absence of fever, male, retreatment, and pulmonary concurrent with extrapulmonary tuberculosis are risk factors for DR-TB in children.

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“… 17 A retrospective study by Xu et al using data between 2015 and 2018 in Chengdu, Sichuan Province, found a drug resistance rate of 24.3% for pediatric TB. 18 A meta-analysis by DiNardo which included 9 studies showed that a total of 939 children with suspected TB had a positive MGIT 960 culture detection rate of 24.4% (229/939), including 22.03% (154/699, median 21.1%, IQR 14.5–38.4%) in children under 5 years and 35.57% in children 5–15 years (69/194, median 31.5%, IQR 23.8–43.4%). 19 Another multicenter study of EPTB in children in mainland China showed a bacteriological positivity rate of 29.88% (401/1342).…”

Section: Discussionmentioning

confidence: 99%

Analysis of Drug-Resistant Tuberculosis in Children in Shenyang, China, 2017–2021

Sun,

Fan,

Zhao

et al. 2023

IDR

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Objective Drug-resistant tuberculosis (DR-TB) in children seriously threatens TB control. Information on the epidemiology and characteristics of DR-TB in children in China is limited. We studied data in Shenyang Tenth People’s Hospital to understand the DR-TB epidemiology in children in Shenyang. Design or Methods We retrospectively analyzed drug resistance testing data of pediatric TB patients between 2017 and 2021, and included 2976 clinically-diagnosed pediatric TB patients. We described the epidemiology of DR-TB and analyzed the trends of DR-TB incidence. The Kappa value was calculated to assess the agreement between MGIT 960 DST and Xpert MTB/RIF for detecting rifampicin resistance. Multivariate logistic regression was used to identify the risk factors for DR-TB in pediatric patients. Results Of the 2976 TB patients, 1076 were confirmed by MGIT 960 culture and/or Xpert MTB/RIF. Among the 806 patients identified by MGIT 960 culture, 232 cases (28.78%) were DR-TB. Resistance to the six drugs was in the following order: streptomycin (21.09%), isoniazid (9.35%), rifampin (15.01%), levofloxacin (6.20%), ethambutol (4.22%), and amikacin (3.23%). Alarmingly, 12.90% were MDR-TB (104/806), including 28 (3.47%) pre-XDR-TB. Of the 1076 pediatric TB patients, 295 (27.4%) developed DR-TB to any one drug (including 69 rifampicin-resistant cases identified by Xpert MTB/RIF only). No difference was found in the incidence of pediatric DR-TB between 2017 and 2021. Among 376 patients who were positive for both methods, using the MGIT 960 DST results as the gold standard, Xpert MTB/RIF’s sensitivity for detecting rifampicin resistance was 91.38% and its specificity was 94.65%. Conclusion Between 2017 and 2021, the DR-TB incidence in children remained unchanged in Shenyang. RR-TB, MDR-TB, and even Pre-XDR-TB require attention in children with drug-resistant TB. Xpert MTB/RIF helped to detect more rifampicin-resistant pediatric patients; thus Xpert MTB/RIF should be widely used as an important complementary tool to detect rifampicin-resistant TB in children.

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The epidemiological characteristics and profile of drug-resistant tuberculosis among children with tuberculosis in Sichuan, China, 2015–2018

Cited by 6 publications

References 22 publications

Analysis of Factors Influencing Multidrug-Resistant Tuberculosis and Validation of Whole-Genome Sequencing in Children with Drug-Resistant Tuberculosis

Analysis of Factors Influencing Multidrug-Resistant Tuberculosis and Validation of Whole-Genome Sequencing in Children with Drug-Resistant Tuberculosis

Trends and risk factors for drug-resistant tuberculosis among children in Sichuan, China: A 10-year retrospective analysis, 2013–2022

Analysis of Drug-Resistant Tuberculosis in Children in Shenyang, China, 2017–2021

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