title: Prevalence of tuberculosis drug resistance in 10 provinces of China.
abstract: 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.
authors.affiliation: National Center for TB control and prevention, China Center for Disease Control and Prevention (CDC), Beijing, PR China.
authors.forename: Guang Xue
authors.initials: GX
authors.lastname: He
authors.forename: Yan Lin
authors.initials: YL
authors.lastname: Zhao
authors.forename: Guang Lu
authors.initials: GL
authors.lastname: Jiang
authors.forename: Yu Hong
authors.initials: YH
authors.lastname: Liu
authors.forename: Hui
authors.initials: H
authors.lastname: Xia
authors.forename: Sheng Fen
authors.initials: SF
authors.lastname: Wang
authors.forename: Li Xia
authors.initials: LX
authors.lastname: Wang
authors.forename: Martien W
authors.initials: MW
authors.lastname: Borgdorff
authors.forename: Marieke J
authors.initials: MJ
authors.lastname: van der Werf
authors.forename: Susan
authors.initials: S
authors.lastname: van den Hof
mesh_terms: 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
chemical_list: D000995:Antitubercular Agents; D004977:Ethambutol; D007538:Isoniazid; D012293:Rifampin; D013307:Streptomycin