title: Proportions and Risk Factors of Developing Multidrug Resistance Among Patients with Tuberculosis in China: A Population-Based Case-Control Study.
abstract: OBJECTIVE
  Limited studies have been conducted to explore risk factors of developing multidrug-resistant tuberculosis (MDR-TB) in China. This study aimed to find the proportions and risk factors of developing MDR-TB in China among new patients and previously treated tuberculosis (TB) patients.
  
  
  METHODS
  A population-based case-control study was conducted from March 2010 to December 2013 in five cities in China. Proportions and risk factors of developing MDR-TB were calculated and analyzed separately for new patients and previously treated patients.
  
  
  RESULTS
  The proportion of MDR-TB was 3.9% among new patients and 25.3% among previously treated patients in our study population. The proportion of extensively drug resistant TB was 0.1% among new patients and 1.4% among previously treated patients in our study population. Multivariate analysis found that being registered as migrants (odds ratio [OR] = 6.08; 95% confidence interval [CI]: 1.75-21.09), having more than three affected lung fields (OR = 2.18; 95% CI: 1.20-2.94), having more than 8 months of initial treatment (OR = 2.15; 95% CI: 1.09-4.28), having more than three prior episodes of anti-TB treatment (OR = 3.10; 95% CI: 1.48-6.48), and experiencing failure or continued worsening from the last treatment (OR = 3.82; 95% CI: 1.86-7.85) were associated with developing MDR-TB in previously treated patients with TB. Univariate analysis showed that less than 30 years of living in the same location (p = 0.034) was a risk factor for new patients with MDR-TB.
  
  
  CONCLUSIONS
  The surveillance of multidrug resistance among patients with previously treated TB who also possess these risk factors and the management of patients with MDR-TB should be reinforced.
authors.affiliation: 1 Department of Epidemiology, School of Public Health, Shandong University , Jinan, China .
authors.forename: Pengcheng
authors.initials: P
authors.lastname: Huai
authors.affiliation: 1 Department of Epidemiology, School of Public Health, Shandong University , Jinan, China .
authors.forename: Xinghe
authors.initials: X
authors.lastname: Huang
authors.affiliation: 2 National Center for Tuberculosis Control and Prevention , China CDC, Beijing, China .
authors.forename: Jun
authors.initials: J
authors.lastname: Cheng
authors.affiliation: 2 National Center for Tuberculosis Control and Prevention , China CDC, Beijing, China .
authors.forename: Canyou
authors.initials: C
authors.lastname: Zhang
authors.affiliation: 3 Department of Epidemiology, University of Florida, Gainesville, Florida.
authors.forename: Kai
authors.initials: K
authors.lastname: Wang
authors.affiliation: 1 Department of Epidemiology, School of Public Health, Shandong University , Jinan, China .
authors.forename: Xinting
authors.initials: X
authors.lastname: Wang
authors.affiliation: 1 Department of Epidemiology, School of Public Health, Shandong University , Jinan, China .
authors.forename: Liping
authors.initials: L
authors.lastname: Yang
authors.affiliation: 1 Department of Epidemiology, School of Public Health, Shandong University , Jinan, China .
authors.forename: Zhengyi
authors.initials: Z
authors.lastname: Deng
authors.affiliation: 1 Department of Epidemiology, School of Public Health, Shandong University , Jinan, China .
authors.forename: Wei
authors.initials: W
authors.lastname: Ma
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000494:pharmacology*; D016022:Case-Control Studies; D002681:China; D002947:Cities; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects* / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000502:physiology; D062486:Public Health Surveillance; D012307:Risk Factors; D013997:Time Factors; D014171:Transients and Migrants; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000382:microbiology*; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy / Q000382:microbiology*
chemical_list: D000995:Antitubercular Agents
keywords: China; multidrug resistance; risk factors; tuberculosis