National survey of drug-resistant tuberculosis in China.
BACKGROUND
The available information on the epidemic of drug-resistant tuberculosis in China is based on local or regional surveys. In 2007, we carried out a national survey of drug-resistant tuberculosis in China.


METHODS
We estimated the proportion of tuberculosis cases in China that were resistant to drugs by means of cluster-randomized sampling of tuberculosis cases in the public health system and testing for resistance to the first-line antituberculosis drugs isoniazid, rifampin, ethambutol, and streptomycin and the second-line drugs ofloxacin and kanamycin. We used the results from this survey and published estimates of the incidence of tuberculosis to estimate the incidence of drug-resistant tuberculosis. Information from patient interviews was used to identify factors linked to drug resistance.


RESULTS
Among 3037 patients with new cases of tuberculosis and 892 with previously treated cases, 5.7% (95% confidence interval [CI], 4.5 to 7.0) and 25.6% (95% CI, 21.5 to 29.8), respectively, had multidrug-resistant (MDR) tuberculosis (defined as disease that was resistant to at least isoniazid and rifampin). Among all patients with tuberculosis, approximately 1 of 4 had disease that was resistant to isoniazid, rifampin, or both, and 1 of 10 had MDR tuberculosis. Approximately 8% of the patients with MDR tuberculosis had extensively drug-resistant (XDR) tuberculosis (defined as disease that was resistant to at least isoniazid, rifampin, ofloxacin, and kanamycin). In 2007, there were 110,000 incident cases (95% CI, 97,000 to 130,000) of MDR tuberculosis and 8200 incident cases (95% CI, 7200 to 9700) of XDR tuberculosis. Most cases of MDR and XDR tuberculosis resulted from primary transmission. Patients with multiple previous treatments who had received their last treatment in a tuberculosis hospital had the highest risk of MDR tuberculosis (adjusted odds ratio, 13.3; 95% CI, 3.9 to 46.0). Among 226 previously treated patients with MDR tuberculosis, 43.8% had not completed their last treatment; most had been treated in the hospital system. Among those who had completed treatment, tuberculosis developed again in most of the patients after their treatment in the public health system.


CONCLUSIONS
China has a serious epidemic of drug-resistant tuberculosis. MDR tuberculosis is linked to inadequate treatment in both the public health system and the hospital system, especially tuberculosis hospitals; however, primary transmission accounts for most cases. (Funded by the Chinese Ministry of Health.).
Chinese Center for Disease Control and Prevention, and Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China.
Yanlin
Y
Zhao
Shaofa
S
Xu
Lixia
L
Wang
Daniel P
DP
Chin
Shengfen
S
Wang
Guanglu
G
Jiang
Hui
H
Xia
Yang
Y
Zhou
Qiang
Q
Li
Xichao
X
Ou
Yu
Y
Pang
Yuanyuan
Y
Song
Bing
B
Zhao
Hongtao
H
Zhang
Guangxue
G
He
Jing
J
Guo
Yu
Y
Wang
D000704:Analysis of Variance; D000995:Antitubercular Agents / Q000627:therapeutic use; D002681:China / Q000453:epidemiology; D024881:Drug Resistance, Bacterial; D058872:Epidemics / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D016017:Odds Ratio; D011159:Population Surveillance; D012307:Risk Factors; D012494:Sampling Studies; D013183:Sputum / Q000382:microbiology; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology* / Q000382:microbiology
D000995:Antitubercular Agents