Abstract
ABSTRACT Background: Multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) hinder the progress of TB control. Objective: To track the trend of drug-resistant tuberculosis (DR-TB) prevalence in Zhejiang Province from 1999 to 2013, and identify risk factors of resistance to second-line drugs among MDR-TB patients. Design: Four DR-TB surveys had been done in Zhejiang Province in 1999, 2004, 2008 and 2013 through questionnaires, in which demographic and epidemiological items were included. After questionnaires, drug susceptibility testing (DST) targeted at four first-line drugs was done for all TB patients and DST targeted at six second-line drugs (only in 2008 and 2013) for MDR-TB patients. The drug resistance trend over time was analyzed using the Cochran–Armitage test. The factors associated with resistance to second-line drugs among MDR-TB patients were examined by a multivariate logistic regression model. Results: Of 936 patients enrolled, 27 (3.21%) and 20 (21.28%) MDR-TB cases were registered as new and previously treated cases, respectively. MDR-TB showed a decreasing trend (Z = −3.31, p < 0.01) while resistance to any first-line drugs showed an increasing trend (Z = 5.22, p < 0.001), from 1999 to 2013. The highest resistance rate was shown to ofloxacin among MDR-TB patients both in 2008 (28.8%) and in 2013 (27.7%), while resistance to para-aminosalicylate decreased significantly (Z = −2.06, p = 0.04) between 2008 and 2013. MDR-TB patients aged 45–65 years (OR = 5.00, p = 0.02) were more likely to be resistant to any second-line drugs. Conclusions: DR-TB including MDR-TB remains a major public health problem in Zhejiang Province. Further efforts on MDR-TB control should be conducted to hinder drug resistance, including critical clinical use of anti-TB antibiotics and preventing transmission.
Highlights
Multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) hinder the progress of TB control
The identification of Tuberculosis and drug susceptibility testing (DST) was performed at the provincial reference laboratory, DST was carried out on LJ media by the proportion method and the same method was used for all drugs, and results were compared with those from the standardized strains
A total of 1010 sputum-positive patients were included in the fourth TB drug resistance surveillance of Zhejiang Province
Summary
Multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) hinder the progress of TB control. Objective: To track the trend of drug-resistant tuberculosis (DR-TB) prevalence in Zhejiang Province from 1999 to 2013, and identify risk factors of resistance to second-line drugs among MDR-TB patients. Further efforts on MDR-TB control should be conducted to hinder drug resistance, including critical clinical use of anti-TB antibiotics and preventing transmission. The prevalence of multidrug-resistant tuberculosis (MDR-TB) in China was estimated to be 1.7 and 1.3 times of the global average among new and previously treated patients respectively in 2014 [1,2]. Due to the high cost of drug-susceptibility testing (DST), monitoring drug resistance time trends has not yet been set up at the national level in China, and DST is not compulsory before initiating treatment on TB patients. DST for first-line drugs (isoniazid [INH], rifampin [RFP], ethambutol [EMB] and streptomycin [SM]) was implemented in each survey but DST for six second-line drugs (ofloxacin [OFX], kanamycin [KM], amikacin [AM], capreomycin [CPM], cycloserine [CS] and para-aminosalicylic acid [PAS]) among MDR-TB was only available in 2008 and 2013
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