Abstract
BackgroundThe emergence of drug-resistant tuberculosis (TB) hampers TB control. Ten provinces in China performed drug resistance surveys among tuberculosis (TB) patients in 1996–2004 to assess levels of drug resistance.MethodsProvincial drug resistance surveys included all isolates from newly diagnosed, smear-positive TB patients. Drug susceptibility testing (DST) against isoniazid, rifampicin, streptomycin and ethambutol was carried out in the provincial laboratories. For purposes of quality assurance, a random sample (11.6%) was re-tested by the national reference laboratory (NRL).ResultsOf 14,059 patients tested 11,052 (79%) were new TB cases. The weighted mean prevalence of multi-drug resistant tuberculosis (MDR-TB) among all cases was 9.3% (range 2.2%–10.4%); 5.4% (range 2.1% – 10.4%) among new cases and 25.6% (range 11.7%–36.9%) among previously treated cases. Adjusting the drug resistance proportions using the re-testing results did not change the estimated national mean prevalence significantly. However, in some individual provinces the estimated resistance proportions were greatly influenced, especially among re-treatment patients.ConclusionMDR-TB levels varied greatly between provinces in China, but on average were high compared to the global estimated average of 4.8%. This study shows the importance of quality-assured laboratory performance. Programmatic management of drug-resistant TB, including high quality DST for patients at high risk of resistance and treatment with second-line drugs, should become the standard, especially in high MDR-TB settings.
Highlights
The emergence of resistance to drugs used to treat tuberculosis, and multi-drug resistant tuberculosis (MDR-TB) [1], has become a significant public health problem in a number of countries and an obstacle to effective global TB control
With an estimated Multi-drug resistant (MDR)-TB proportion of 4.8% among incident TB cases globally, almost half a million (489,139) cases of MDR-TB are estimated to emerge world-wide every year [1]
On average resistance proportions were highest for streptomycin (16.4%) and isoniazid (14.0%), intermediate for rifampicin (7.2%) and lowest for ethambutol (3.3%)
Summary
The emergence of resistance to drugs used to treat tuberculosis, and multi-drug resistant tuberculosis (MDR-TB) [1], has become a significant public health problem in a number of countries and an obstacle to effective global TB control. Treatment of MDR-TB, requires use of costly, toxic and less effective second-line drugs for at least 18 months because the bacilli are resistant to the most effective firstline drugs rifampcin and isoniazid [2]. In case of extensively drug-resistant TB (XDR-TB), i.e. MDR-TB with additional resistance to any fluoroquinolone and at least one of the three injectable second-line anti-TB drugs (i.e. amikacin, kanamycin, capreomycin), treatment options are seriously limited[3]. The emergence of drug-resistant tuberculosis (TB) hampers TB control. Ten provinces in China performed drug resistance surveys among tuberculosis (TB) patients in 1996– 2004 to assess levels of drug resistance
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