title: Epidemiological Trends of Drug-Resistant Tuberculosis in China From 2007 to 2014: A Retrospective Study.
abstract: The emergence and spread of drug-resistant tuberculosis (DR-TB) has become the major concern in global TB control nowadays due to its limited therapy options and high mortality. A comprehensive evaluation for the epidemiological trends of DR-TB in mainland China, of which TB incidences remain high, is essential but lacking. This study aimed to describe the trends of DR-TB overtime, especially multidrug-resistant TB (MDR-TB); and to identify unique characteristics of MDR-TB cases compared with drug-susceptible TB cases in Mainland China. We retrospectively analyzed surveillance data collected from 36 TB prevention and control institutions in Shandong Province, China over an 8-year period. Unique characteristics of MDR-TB were identified; Chi-square test for trends and linear regression were used to assess the changes in proportions of different resistance patterns overtime. The overall MDR rate was 6.2% in our sample population. There were no statistically significant changes in the percentage of drug-susceptible, isoniazid (INH) resistance, ethambutol (EMB) resistance, streptomycin (SM) resistance, and MDR TB during our study period except that the overall rifampin (RFP) resistance and rifampin monoresistance (RMR) increased at a yearly rate of 0.2% and 0.1%, respectively. Among those with known treatment histories, a higher MDR rate of 8.7% was observed, in which 53.9% were primary MDR-TB patients, and this rate was increasing at a yearly rate of 4.1% over our study period. MDR-TB patients were more likely to be female (odds ratio [OR], 1.23; 95% confidence interval [CI], 1.05-1.34), aged 25 to 44 years (OR, 1.67; 95%CI, 1.45-1.93), retreated (OR, 11.95; 95%CI, 9.68-14.76), having prior TB contact (OR, 1.89; 95%CI, 1.19-2.78) and having cavity (OR, 1.57; 95%CI 1.36-1.81), or bilateral disease (OR, 1.45; 95%CI 1.19-1.76) on chest radiology. Persistent high levels of MDR-TB, increasing rates of primary MDR-TB and RMR characterize DR-TB cases in mainland China; community-acquired drug resistance may be one of the most modifiable factors in future TB control strategies.
authors.affiliation: From the Department of Respiratory Medicine (X-CH, YL, H-CL), Shandong Provincial Hospital Affiliated to Shandong University, Jinan; College of Pharmacy (X-CH), Shandong University, Jinan; Department of Respiratory Medicine (X-XZ), Shandong Provincial Chest Hospital, Jinan; Department of Respiratory Medicine (J-NZ), The First Hospital of Jiaxing, Jiaxing; Katharine Hsu International Research Center of Human Infectious Diseases (C-BY), Shandong Provincial Chest Hospital, Jinan; and Department of Respiratory and Critical Care Medicine (G-RY), The Second People's Hospital of Weifang, Weifang, China.
authors.forename: Xiao-Chun
authors.initials: XC
authors.lastname: He
authors.forename: Xian-Xin
authors.initials: XX
authors.lastname: Zhang
authors.forename: Jiang-Nan
authors.initials: JN
authors.lastname: Zhao
authors.forename: Yao
authors.initials: Y
authors.lastname: Liu
authors.forename: Chun-Bao
authors.initials: CB
authors.lastname: Yu
authors.forename: Guo-Ru
authors.initials: GR
authors.lastname: Yang
authors.forename: Huai-Chen
authors.initials: HC
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000494:pharmacology*; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D004977:Ethambutol / Q000494:pharmacology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007538:Isoniazid / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012111:Residence Characteristics; D012189:Retrospective Studies; D012293:Rifampin / Q000494:pharmacology; D013307:Streptomycin / Q000494:pharmacology; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents; D004977:Ethambutol; D007538:Isoniazid; D012293:Rifampin; D013307:Streptomycin