The Prevalence of Drug-Resistant Tuberculosis in Mainland China: An Updated Systematic Review and Meta-Analysis

Duan, Qionghong; Chen, Zi; Chen, Cong; Zhengbin, Zhang; Lu, Zhouqin; Yang, Yalong; Zhang, Lin

doi:10.1371/journal.pone.0148041

Cited by 41 publications

(42 citation statements)

References 8 publications

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“…Sharma et al reported a higher proportion of drug resistance in defaulters among previously treated patients in Delhi [24]. Similar results to our study were reported by Baya et al (OR = 3.82, 95% CI (1.87-7.79), p = 0.0002) [20]. This may be because in failure cases, the bacteria have a higher chance of developing resistance due to prolonged exposure to the drugs and also the bacteria are expected to be more resilient to the drugs which led to a failure of treatment in the first place.…”

Section: Discussionsupporting

confidence: 91%

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Determinants of Drug Resistance in Previously-Treated Pulmonary Tuberculosis Patients Registered at a Chest Clinic in South Delhi, India

Sharma¹,

Roy²,

Banerjee³

et al. 2019

Cureus

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Introduction Drug-resistant tuberculosis (DR-TB) is a major concern to effective control of tuberculosis (TB) in India and the likelihood of drug resistance increases with repeated exposure to anti-TB drugs. India has emerged as one of the leading contributors of DR-TB in the world posing a major threat to TB control. In the current study, we aim to find the burden and factors associated with drug resistance in previously treated pulmonary TB patients. Methods A cross-sectional study was conducted among 230 previously treated pulmonary TB patients registered with Directly Observed Treatment, Short-course (DOTS) centers under Nehru Nagar Chest clinic in Delhi, India. The participants were selected consecutively as they registered with the chest clinic. A predesigned, pretested, semi-structured questionnaire in the Hindi language used to collect socio-demographic data and factors associated with the development of drug resistance. Physical examination of all the participants was done (height, weight, pallor). Data were analyzed using SPSS version 21. Binary logistic regression analysis was used to identify independent risk factors of drug resistance. Results Of 230 previously treated pulmonary TB patients, 80 (34.8% (95% CI:28.7-40.9%)) were drug-resistant. Age (p=0.021), ever consumption of alcohol (p= 0.001), pallor (p=0.06), BMI (p=0.028), fasting blood sugar (p=0.001), treatment failure (p=0.005) and the number of prior courses of anti-tuberculosis treatment (ATT) taken (p=0.004) were significantly associated with drug resistance. On applying binary logistic regression analysis, independently associated factors with drug resistance were ever consumption of alcohol, pallor, high fasting blood sugar level, previous treatment failure patients and the number of prior courses of ATT (p<0.05). Conclusion The findings of this study revealed that patients who had pallor, high fasting blood sugar, treatment failure and who had two or more prior courses of ATT were more likely to have DR-TB. Identifying the risk factors for drug-resistant TB is essential in facilitating the government to draw public health interventions. Further research is warranted to explore the causal associations.

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Section: Discussionsupporting

confidence: 91%

“…As per some Indian studies, the prevalence of any drug resistance among previously treated TB patients was 37%-62.77% [6,[16][17]. As per a few international studies, the prevalence of any drug resistance among previously treated TB patients was between 7.7%-81.7% [18][19][20].…”

Section: Discussionmentioning

confidence: 94%

Determinants of Drug Resistance in Previously-Treated Pulmonary Tuberculosis Patients Registered at a Chest Clinic in South Delhi, India

Sharma¹,

Roy²,

Banerjee³

et al. 2019

Cureus

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“…In the end, we found out older age, previous treatment history and poor compliance as independent susceptibility factors for MDR/RR-TB, which were consistent with other studies (Duan et al, 2016;Li et al, 2016;Lv, Lu, Shi, & Zhou, 2017). More importantly, we reported, for the first time that allele HLA-DRB1*08:01 was an independent risk factor for MDR/RR-TB, especially for primary transmitted MDR/RR-TB in the Han population from Hubei province, China, which warrants further studies with larger sample size.…”

Section: Discussionsupporting

confidence: 92%

Genetic polymorphism of human leucocyte antigen and susceptibility to multidrug‐resistant and rifampicin‐resistant tuberculosis in Han Chinese from Hubei Province

Zhou

Yang

et al. 2017

Int J Immunogenetics

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We determined the high-resolution allele and haplotype frequencies at the human leucocyte antigen (HLA)A, B and DRB1 loci in the Han population of Hubei province, the TB endemic area of Central China, with pulmonary tuberculosis (PTB), and established the relationship between HLA-A, B and DRB1 alleles as well as haplotypes and susceptibility to multidrug-resistant and rifampicin-resistant tuberculosis (MDR/RR-TB). Blood samples were drawn from 174 patients with MDR/RR-TB and 838 patients with drug-susceptible PTB in ethnic Han population from Hubei province (central China). Four-digit allele genotyping of HLA- A, B and DRB1 loci was performed using polymerase chain reaction with sequence-specific oligonucleotide probes (PCR- SSOP). The allele and haplotype frequencies of HLA-A, B and DRB1 were determined and compared between patients with MDR/RR-TB and patients with drug-susceptible PTB. Statistical analysis of the generated data indicated no departure from expectation of Hardy-Weinberg equilibrium (HWE) at all loci of the control group. Multivariate analysis identified allele DRB1*08:01 (p < .0001; OR = 174.5, 95% CI 15.3-1987.2) as independent predictor of MDR/RR-TB, except for old age (p < .0001; OR = 10. 9, 95% CI 7.6-15.8), previous treatment history (p < .0001; OR = 11.0, 95% CI 7.2-16.7) and poor compliance to treatment (p < .0001; OR = 12.9, 95% CI 8.4-20.0). While in the subgroup of new TB cases, DRB1*08:01 (p < .0001; OR = 80.3, 95% CI 7.0-917.1) and older age (p < .0001; OR = 3.9, 95% CI 2.4-6.4) were independent susceptibility factors for primary MDR/RR-TB. Our results suggest that a combination of clinical and host genetic information about tuberculosis patients may contribute to prediction and early detection of MDR/RR-TB.

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“…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: Discussionsupporting

confidence: 89%

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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The Prevalence of Drug-Resistant Tuberculosis in Mainland China: An Updated Systematic Review and Meta-Analysis

Cited by 41 publications

References 8 publications

Determinants of Drug Resistance in Previously-Treated Pulmonary Tuberculosis Patients Registered at a Chest Clinic in South Delhi, India

Determinants of Drug Resistance in Previously-Treated Pulmonary Tuberculosis Patients Registered at a Chest Clinic in South Delhi, India

Genetic polymorphism of human leucocyte antigen and susceptibility to multidrug‐resistant and rifampicin‐resistant tuberculosis in Han Chinese from Hubei Province

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

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