title: Laboratory-Based Surveillance of Extensively Drug-Resistant Tuberculosis in Eastern China.
abstract: With 25% of the global burden, China has the highest incidence of drug-resistant tuberculosis (TB) in the world. However, surveillance data on extensively drug-resistant TB (XDR-TB) from China are scant. To estimate the prevalence of XDR-TB in Zhejiang, Eastern China, 30 of 90 TB treatment centers in Zhejiang were recruited. Patients with suspected TB who reported to the clinics for diagnosis were requested to undergo a smear sputum test. Positive sputum samples were tested for drug susceptibility. Data on anti-TB drug resistance from 1999 to 2008 were also collected to assess drug resistance trends. A total of 931 cases were recruited for drug susceptibility testing (DST). Among these, 23.6% (95% confidence interval [CI], 18.8-24.4) were resistant to any of the following drugs: isoniazid, rifampin, streptomycin, and ethambutol. Multidrug resistant (MDR) strains were identified in 5.1% of all cases (95% CI, 3.61-6.49). Among MDR-TB cases, 6.4% were XDR (95% CI, 1.7-18.6) and 8.9% (95% CI, 7.0-10.8) of all cases were resistant to either isoniazid or rifampin (but not both). Among MDR-TB cases, 23.4% (95% CI, 12.8-38.4) were resistant to either fluoroquinolones or a second-line anti-TB injectable drug, but not both. From 1999 to 2014, the percentage of MDR cases decreased significantly, from 8.6% to 5.1% (p = 0.00). The Global Fund to Fight TB program showed signs of success in Eastern China. However, drug-resistant TB, MDR-TB, and XDR-TB still pose a challenge for TB control in Eastern China. High-quality directly observed treatment, short-course, and universal DST for TB cases to determine appropriate treatment regimens are urgently needed to prevent acquired drug resistance.
authors.affiliation: 1 Department of Tuberculosis, Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou, China .
authors.forename: Yu
authors.initials: Y
authors.lastname: Huang
authors.affiliation: 2 Department of Health Education, Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou, China .
authors.forename: Qingqing
authors.initials: Q
authors.lastname: Wu
authors.affiliation: 2 Department of Health Education, Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou, China .
authors.forename: Shuiyang
authors.initials: S
authors.lastname: Xu
authors.affiliation: 3 Department of Chronic Disease, Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou, China .
authors.forename: Jieming
authors.initials: J
authors.lastname: Zhong
authors.affiliation: 1 Department of Tuberculosis, Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou, China .
authors.forename: Songhua
authors.initials: S
authors.lastname: Chen
authors.affiliation: 2 Department of Health Education, Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou, China .
authors.forename: Jinghang
authors.initials: J
authors.lastname: Xu
authors.affiliation: 1 Department of Tuberculosis, Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou, China .
authors.forename: Liping
authors.initials: L
authors.lastname: Zhu
authors.affiliation: 1 Department of Tuberculosis, Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou, China .
authors.forename: Haibo
authors.initials: H
authors.lastname: He
authors.affiliation: 1 Department of Tuberculosis, Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou, China .
authors.forename: Xiaomeng
authors.initials: X
authors.lastname: Wang
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use; D002681:China / Q000453:epidemiology; D054908:Extensively Drug-Resistant Tuberculosis / Q000188:drug therapy / Q000453:epidemiology*; D024841:Fluoroquinolones / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D015995:Prevalence; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000453:epidemiology*
chemical_list: D000995:Antitubercular Agents; D024841:Fluoroquinolones
keywords: drug susceptibility test; extensively drug resistant tuberculosis; multi-drug resistant tuberculosis; tuberculosis