Prevalence of tuberculosis drug resistance in 10 provinces of China.
BACKGROUND
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.


METHODS
Provincial 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).


RESULTS
Of 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.


CONCLUSIONS
MDR-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.
He
Guang Xue
GX
National Center for TB control and prevention, China Center for Disease Control and Prevention (CDC), Beijing, PR China.
Zhao
Yan Lin
YL
Jiang
Guang Lu
GL
Liu
Yu Hong
YH
Xia
Hui
H
Wang
Sheng Fen
SF
Wang
Li Xia
LX
Borgdorff
Martien W
MW
van der Werf
Marieke J
MJ
van den Hof
Susan
S
D000995:Antitubercular Agents / Q000494:pharmacology*; D002681:China / Q000453:epidemiology; D024901:Drug Resistance, Multiple, Bacterial; D004977:Ethambutol / Q000494:pharmacology; D006801:Humans; D007538:Isoniazid / Q000494:pharmacology; D008826:Microbial Sensitivity Tests; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000302:isolation & purification*; D015995:Prevalence; D015203:Reproducibility of Results; D012293:Rifampin / Q000494:pharmacology; D013183:Sputum / Q000382:microbiology; D013307:Streptomycin / Q000494:pharmacology; D014376:Tuberculosis / Q000453:epidemiology / Q000382:microbiology; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology* / Q000382:microbiology; D014944:World Health Organization
D000995:Antitubercular Agents; D004977:Ethambutol; D007538:Isoniazid; D012293:Rifampin; D013307:Streptomycin