Abstract
BackgroundExtensively Drug-Resistant (XDR) Tuberculosis (TB) has posed a great threat to global health and finance systems, especially for developing countries with high TB and Multidrug-Resistant (MDR) TB burden.MethodsWe retrospectively analyzed HIV-uninfected TB case confirmed and treated in Shandong Provincial Chest Hospital (SPCH) between January 2008 and December 2015. Unique characteristics of XDR-TB were identified; its longitudinal changes and survival were analyzed.ResultsBetween January 2008 and December 2015, a total of 144 cases were confirmed to be XDR-TB (2.5% of 5663 culture-confirmed TB cases; 27.9% of 516 MDR-TB cases). The proportion of XDR TB cases among MDR-TB cases has increased from 26.5% in 2008 to 44.5% in 2014 (Chi-Square test for trends: P < 0.01). Among the 144 XDR-TB cases, 21 patients (14.6%) had treatment success, 123 (85.1%) had poor treatment outcomes. Mortality was higher among XDR-TB cases than among MDR TB cases (8.3% vs. 3.8%, P = 0.033) and drug-susceptible TB cases (8.3% vs. 2.1%, P < 0.01).ConclusionsXDR-TB cases comprise a substantial and increasing fraction of MDR-TB cases, causing poor treatment outcomes and high mortalities. Early drug susceptibility testing, adequate TB treatment and efficient infection control must be in place in future TB control strategies.
Highlights
Drug-Resistant (XDR) Tuberculosis (TB) has posed a great threat to global health and finance systems, especially for developing countries with high TB and Multidrug-Resistant (MDR) TB burden
Extensively drug-resistant tuberculosis (XDR-TB), which is defined as tuberculosis resistant to isoniazid, rifampin, a fluoroquinolone, and a second-line injectable agent, has posed a great threat to global public health [1,2,3]
In previous studies, not all of the Multidrug-resistant tuberculosis (MDR-TB) cases were XDR-TB evaluable and there were less second line drugs included in the drug susceptibility test (DST) panel, which may have led to selection bias and underestimation of the XDR TB prevalence
Summary
Drug-Resistant (XDR) Tuberculosis (TB) has posed a great threat to global health and finance systems, especially for developing countries with high TB and Multidrug-Resistant (MDR) TB burden. Drug-resistant tuberculosis (XDR-TB), which is defined as tuberculosis resistant to isoniazid, rifampin, a fluoroquinolone, and a second-line injectable agent, has posed a great threat to global public health [1,2,3]. The proportion of XDR-TB among MDR-TB cases was highest in Belarus (29%), Georgia (15%), Latvia (19%) and Lithuania (25%) [15]. China is a country of high TB and MDR-TB burden and a countrywide survey in 2007 revealed that the proportion of XDR-TB among MDR-TB cases was 8% [15, 16]. Systematic data on the epidemiology of XDR-TB remain limited, and most reports focus on populations from special surveys or go through short time intervals, information such as longitudinal changes
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