Epidemiology of anti-tuberculosis drug resistance in a chinese population: current situation and challenges ahead

BMC Public Health

Research Article

Honghuan Song¹  Dandan Yang¹  Weiguo Xu¹  Yan Shao¹  Wei Lu¹  Jianming Wang²  Hongbing Shen²  Yaoyao Dai² 

[1] Department of Chronic Infectious Diseases, Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, PR China;Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, PR China;

关键词: Drug Resistance;    Drug Susceptibility Test;    Sputum Smear Microscopy;    Previous Treatment History;    Provincial Reference Laboratory;   

DOI  :  10.1186/1471-2458-11-110

 received in 2010-08-31, accepted in 2011-02-17,  发布年份 2011

来源: Springer

【 摘 要 】

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.

【 授权许可】

Unknown   
© Shao et al; licensee BioMed Central Ltd. 2011. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.