Abstract
BackgroundDrug resistance has been a cause of concern for tuberculosis (TB) control in both developed and developing countries. Careful monitoring of the patterns and trends of drug resistance should remain a priority.MethodsStrains were collected from 1824 diagnosed sputum smear positive pulmonary TB patients in Jiangsu province of China and then tested for drug susceptibility against rifampicin, isoniazid, ethambutol and streptomycin. The prevalence and patterns of drug resistance in mycobacterium tuberculosis (MTB) isolates were investigated. Multiple logistic regression analysis was performed to identify the risk factors for multidrug resistant (MDR) bacterial infection. The strength of association was estimated by odds ratio (OR) and 95% confidence interval (95% CI).ResultsThe drug susceptibility tests showed that 1077(59.05%) MTB strains were sensitive to all the four antibiotics and the other 747(40.95%) strains were resistant to at least one drug. The proportions of mono-drug resistance were 28.73% for isoniazid, 19.41% for rifampicin, 29.33% for streptomycin, and 13.98% for ethambutol, respectively. The prevalence of MDR-TB was 16.61%, which was significantly different between new cases (7.63%) and those with previous treatment history (33.07%). Geographical variation of drug resistance was observed, where the proportion of MDR-TB among new cases was higher in the central (9.50%) or north part (9.57%) than that in the south area (4.91%) of Jiangsu province. The age of patients was significantly associated with the risk of drug resistance (P < 0.001) and the adjusted OR (95% CI) was 1.88(1.26-2.81) for patients aged 35-44 years when compared with those 65 years or older. Patients with previous treatment history had a more than 5-fold increased risk of MDR-TB (adjusted OR: 6.14, 95% CI: 4.61-8.17), compared with those previously not having been treated.ConclusionsThe high prevalence of drug resistance has been a major challenge for TB control. Prevention and control of drug-resistant TB should be emphasized by the revised DOTS (direct observed therapy, short course) program through prompt case detection, routine and quality-assured drug susceptibility test for patients at high risk of resistance, programmatic treatment with both first and second-line medicines, and systematic treatment observation, with priority for high MDR-TB settings.
Highlights
Drug resistance has been a cause of concern for tuberculosis (TB) control in both developed and developing countries
Thirty counties from Jiangsu province were selected systematically and the sample size was estimated based on the following parameters: (1) The annual reported new sputum smear positive (SS+) cases were 23603 and previously treated SS+ cases were 5524; (2) The precision was set at 2% for new cases and 4% for previously treated cases; (3) The initial mono-drug resistance rate was set at 6% among new cases and 16% among previously treated cases based on the proportion of rifampicin resistant isolates from a pilot study with small sample size; the sample size was amplified by taking into account the design effect of the cluster sampling method and potential no-response of study subjects
303(16.61%) strains were resistant to both INH and RIF (MDR-TB), and 146 (8.00%) strains were resistant to all four first-line antituberculosis drugs (Table 2, Figure 2)
Summary
Drug resistance has been a cause of concern for tuberculosis (TB) control in both developed and developing countries. Careful monitoring of the patterns and trends of drug resistance should remain a priority. China reported a high proportion of drug resistance with the highest burden of cases in the world, just following the countries of the former Soviet Union [8]. China has reached the global targets for case detection and treatment success but careful monitoring of the patterns and trends of drug resistance should remain a priority. In order to obtain insights into the prevalence and distribution of anti-tuberculosis drug resistance, China joined the global surveillance project organized by WHO/IUATLD (World Health Organization/International Union against Tuberculosis and Lung Diseases). Until now, no study has been conducted to investigate the current situation and patterns of drug resistance among TB patients at the provincial level in Jiangsu
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