Determining Mycobacterium tuberculosis Drug Resistance and Risk Factors for Multidrug-Resistant Tuberculosis in Sputum Smear-Positive Tuberculosis Outpatients in Anhui Province, China, 2015-2016

Song Yao; Junwei Yan; Ling Li; Dongchun Ma; Jie Liu; Qing Wang; Aimin Wang; Fangjin Bao; Zekun Zhang; Xundi Bao

doi:10.2147/IDR.S244482

Determining Mycobacterium tuberculosis Drug Resistance and Risk Factors for Multidrug-Resistant Tuberculosis in Sputum Smear-Positive Tuberculosis Outpatients in Anhui Province, China, 2015-2016

Infect Drug Resist. 2020 Apr 9:13:1023-1032. doi: 10.2147/IDR.S244482. eCollection 2020.

Authors

Song Yao^#¹, Junwei Yan^#², Ling Li¹, Dongchun Ma¹, Jie Liu¹, Qing Wang¹, Aimin Wang¹, Fangjin Bao¹, Zekun Zhang¹, Xundi Bao¹

Affiliations

¹ Tuberculosis Prevention and Treatment Institute of Anhui Province (Anhui Chest Hospital), Hefei 230022, Anhui, People's Republic of China.
² Affiliated Psychological Hospital of Anhui Medical University, Hefei Fourth People's Hospital, Anhui Metal Health Center, Hefei, People's Republic of China.

^# Contributed equally.

Abstract

Background: Multidrug-resistant tuberculosis (MDR-TB) is currently a major problem in China. The prevention and treatment work for MDR-TB patients started late in Anhui province. To determine the prevalence of MDR-TB in sputum smear-positive TB patients (SSPTBPs) and analyze the risk factors for MDR-TB in Anhui province, we conducted an investigation of drug resistance among SSPTB outpatients from September 2015 to August 2016.

Methods: A stratified cluster-randomized sampling method was used to obtain a representative sample. It was estimated that 2290 new cases and 440 previously treated cases of SSPTBPs needed to be recruited from 40 survey sites. Isolates were tested for resistance to six first-line and second-line anti-TB drugs. Information from patient questionnaire survey was used to identify factors linked to MDR-TB.

Results: Finally, a total of 3047 SSPTBPs were recruited from 40 survey sites; of these, 2530 specimens were successfully cultured and had drug susceptibility testing done. The proportions of rifampin resistant (RR)-TB were 11.42% (289/2530, 95% CI: 10.18-12.66%), 7.64% (163/2133, 95% CI: 6.38-8.62%) and 31.74% (126/397, 95% CI: 27.38-36.60%) in all cases, new cases and previously treated cases, respectively, and the proportions of confirmed MDR-TB were 7.63% (193/2530, 95% CI: 6.59-8.66%), 4.97% (106/2133, 95% CI: 4.05-5.89%) and 21.91% (87/397, 95% CI: 17.83-26.00%), respectively. The ofloxacin resistance rate in previously treated SSPTBPs reached 21.66% (95% CI: 17.33-26.75%). Patients who had received two or more anti-TB treatment courses were significantly associated with MDR-TB compared to patients who have received one anti-TB course.

Conclusion: MDR-TB prevalence was high among SSPTBPs in Anhui province, and past anti-TB treatment course was associated with MDR-TB.

Keywords: Mycobacterium tuberculosis; drug resistance; multidrug-resistant; tuberculosis.

Grants and funding

This study was granted by the “2015 Anhui Provincial Health Planning Commission Research Project (15tb010)”. The sponsors of this study had no role in study design, data collection, data analysis, data interpretation, and writing of the manuscript.