title: Factors contributing to the high prevalence of multidrug-resistant tuberculosis among previously treated patients: a case-control study from China.
abstract: METHODS
  Multidrug-resistant tuberculosis (MDR-TB) has emerged as a serious global public health problem. In China, the risk factors for MDR-TB have not been systematically evaluated.
  
  
  OBJECTIVE
  To identify risk factors associated with MDR-TB among previously treated patients in China.
  
  
  METHODS
  A case-control study was carried out. Cases were selected from previously treated MDR-TB patients who were resistant to both isoniazid and rifampin, and controls were selected from previously treated TB patients who were sensitive to isoniazid and rifampin (non-MDR-TB). Information was collected from the registration database and a structured questionnaire.
  
  
  RESULTS
  A total of 61 cases and 50 controls were recruited. A multivariate analysis showed that the family annual per-capita income ≤7,000 Yuan (odds ratio [OR]=3.238; 95% confidence interval [CI]: 1.270-8.252), no history of fixed dose combinations (FDCs) in anti-TB treatment (OR=4.027; 95% CI: 1.457-11.129), and adverse reactions in the course of TB treatment (OR=3.568; 95% CI: 1.402-9.085) were independent predictors of MDR-TB. Moreover, among the TB patients who had adverse reactions, quitting the treatment was shown as a risk factor for MDR-TB (p=0.009).
  
  
  CONCLUSIONS
  In the control of MDR-TB among previously treated patients, lower socioeconomic groups, the expanding use of FDCs, and improving adherence to treatment by implementing Directly Observed Therapy Short Course-Plus (DOTS-Plus), strictly should become a priority that requires strong commitment and collaboration among health organizations.
authors: 1 Department of Epidemiology and Health Statistics, Shandong University School of Public Health , Jinan, China .
authors: Kai
authors: K
authors: Wang
authors: Songhua
authors: S
authors: Chen
authors: Xiaomeng
authors: X
authors: Wang
authors: Jieming
authors: J
authors: Zhong
authors: Xinting
authors: X
authors: Wang
authors: Pengcheng
authors: P
authors: Huai
authors: Limin
authors: L
authors: Wu
authors: Lixia
authors: L
authors: Wang
authors: Shiwen
authors: S
authors: Jiang
authors: Jun
authors: J
authors: Li
authors: Ying
authors: Y
authors: Peng
authors: Hongyan
authors: H
authors: Yao
authors: Wei
authors: W
authors: Ma
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D002681:China; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D007182:Income; D007538:Isoniazid / Q000627:therapeutic use*; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000472:pathogenicity / Q000502:physiology; D010349:Patient Compliance / Q000523:psychology; D012293:Rifampin / Q000627:therapeutic use*; D012307:Risk Factors; D011795:Surveys and Questionnaires; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000191:economics / Q000382:microbiology / Q000523:psychology; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000191:economics / Q000382:microbiology / Q000523:psychology
chemical_list: D000995:Antitubercular Agents; D007538:Isoniazid; D012293:Rifampin