Proportions and Risk Factors of Developing Multidrug Resistance Among Patients with Tuberculosis in China: A Population-Based Case–Control Study

Risk factors for multidrug-resistant tuberculosis: a predictive model study

Objective

To investigate the risk factors associated with Multidrug-resistant tuberculosis (MDR-TB) in people with drug-resistant tuberculosis (DR-TB) and develop a predictive model.

Methods

A total of 893 individuals with DR-TB treated at Wenzhou Central Hospital from January 2018 to December 2022 were included in the study after excluding 178 individuals with incomplete clinical and laboratory data, leaving 715 individuals for analysis. Data on demographic information, baseline clinical characteristics, laboratory and imaging results, and clinical diagnosis were collected to identify the risk factors for MDR-TB and establish a predictive model.

Results

Multivariate logistic regression analysis identified residence in rural areas, retreatment of TB, presence of pulmonary cavity, uric acid (UA) ≥ 346 μmol/L and c-reactive protein (CRP) < 37.3 mg/L as independent risk factors for MDR-TB in individuals with DR-TB. A nomogram model was constructed using these five factors to predict the risk of MDR-TB, with an area under the ROC curve (AUC) of 0.758 for the training group and 0.775 for the validation group. Calibration curve analysis showed good agreement between predicted and actual MDR-TB incidence in both groups, and decision curve analysis showed that the nomogram model had a higher rate of clinical net benefit.

Conclusion

This study suggests that residence, types of TB treatment, presence of pulmonary cavity, UA and CRP are associated with MDR-TB occurrence in individuals with DR-TB, and the nomogram model developed in this study shows promising predictive value.

Risk factors of multidrug-resistant tuberculosis in China: A meta-analysis

BACKGROUND

Multidrug-resistant tuberculosis (MDR-TB) brings major challenges to the health care workers (HCWs). This study is to determine the risk factors for MDR-TB, latent tuberculosis infection (LTBI), and tuberculosis (TB) disease among HCWs in China.

METHODS

A meta-analysis was conducted to evaluate the risk factors for MDR-TB, LTBI, and TB disease among HCWs using a random-effects model, and the pooled odds ratios (ORs) with 95% confidence interval (CI) were used as effect indicators.

RESULTS

We identified 46 eligible studies and found eight factors were associated with MDR. The ORs with 95% CI are migrant population 1.96 (95% CI, 1.50-2.57), low family income 2.23 (95% CI, 1.74-2.85), retreatment 7.22 (95% CI, 5.63-9.26), anti-TB treatment history 5.65 (95% CI, 4.80-6.65), multiple episodes of treatment 3.28 (95% CI, 2.60-4.13), adverse reactions 3.48 (95% CI, 2.54-4.76), interrupted treatment 3.18 (95% CI, 2.60-3.89), and lung cavities 1.42 (95% CI, 1.14-1.77). Work duration as a HCW for 5 years and above increased the risk of LTBI and TB. HCWs aged 30 years and above were more susceptible to TB (OR = 1.70, 95% CI: 1.37-2.09).

CONCLUSION

The risk factors for MDR-TB in China are possibly migrant population, low family income, retreatment, anti-TB treatment history, adverse reactions, interrupted treatment, and lung cavities. Longer work duration and greater age are risk factors for LTBI and TB among HCWs.

Prevalence and patterns of drug resistance among pulmonary tuberculosis patients in Hangzhou, China

Background

To evaluate prevalence and patterns of drug resistance among pulmonary tuberculosis (TB) patients in Hangzhou City, China.

Methods

Sputum samples of smear positive TB patients enrolled in 2011 and 2015 were collected and tested for drug susceptibility, and demographic and medical record data were extracted from the electronic database of China Information System for Disease Control and Prevention. Chi-square test was used to compare drug resistance prevalence between new and treated patients and between male and female patients, and Chi-square test for trend was used to compare the prevalence over calendar years 2011 and 2015.

Results

Of 1326 patients enrolled in 2015, 22.3% had resistance to any first-line anti-TB drugs and 8.0% had multi-drug resistance (MDR); drug resistance rates among previously treated cases were significantly higher than among new cases. Significant declines of resistance to isoniazid, rifampin, ethambutol and streptomycin, and MDR from 2011 to 2015 were observed among previously treated patients, while a significant decline of resistance to rifampin was observed among new cases.

Conclusions

While the prevalence of acquired drug resistance decreased due to due to implementation of DOTS-Plus program, the prevalence of primary drug resistance due to transmission remained high. Greater efforts should be made to screen drug resistance for case finding and to reduce transmission through improving the treatment and management of drug-resistant patients.

Distinct Prevalence of Drug-Resistant Tuberculosis in Gansu, China: A Retrospective Study on Drug Susceptibility Profiles Between 2010 and 2014

Limited knowledge is available on regional distribution of antituberculosis (TB) drug resistance and on province-specific time-trends in TB drug susceptibility in China. To obtain the latest information about the dynamics of drug-resistant TB in Gansu province, we conducted a retrospective study and analyzed data on drug resistance among new TB cases diagnosed between June 2010 and May 2014 in Gansu, China. The data were collected from the only TB surveillance and treatment hospital in Gansu and, therefore, represented the epidemiology of TB in the province. The drug resistance was defined based on diagnostic drug susceptibility testing. Overall, 17.3% of TB new cases diagnosed during 2010 to 2014 in Gansu presented resistance to at least one anti-TB drug. And a total of 2.9% of new TB cases have multidrug resistance. The prevalence of multidrug-resistant TB in Gansu was found to resurge after 2013 (2.0%) after a steady decline between 2010 and 2012 (from 7.1% to 1.2%). The drug resistance patterns of TB and their revolution trends in Gansu differed from other regions of China. We report the first epidemiological description of drug-resistant TB in Gansu, which is distinct when compared to other regions. Our data demonstrate that the distribution of drug-resistant TB varies to a great extent among different geographic regions. And the results of our study greatly suggest that the implementation of individualized TB management and regimen policy based on the regional epidemiology of TB drug susceptibility is highly required.

Individualizing management of extensively drug-resistant tuberculosis: diagnostics, treatment, and biomarkers

INTRODUCTION

Success rates for treatment of extensively drug resistant tuberculosis (XDR-TB) are low due to limited treatment options, delayed diagnosis and inadequate health care infrastructure. Areas covered: This review analyses existing programmes of prevention, diagnosis and treatment of XDR-TB. Improved diagnostic procedures and rapid molecular tests help to select appropriate drugs and dosages. Drugs dosages can be further tailored to the specific conditions of the patient based on quantitative susceptibility testing of the M. tuberculosis isolate and use of therapeutic drug monitoring. Pharmacovigilance is important for preserving activity of the novel drugs bedaquiline and delamanid. Furthermore, biomarkers of treatment response must be developed and validated to guide therapeutic decisions. Expert commentary: Given the currently poor treatment outcomes and the association of XDR-TB with HIV in endemic regions, a more patient oriented approach regarding diagnostics, drug selection and tailoring and treatment evaluation will improve treatment outcome. The different areas of expertise should be covered by a multidisciplinary team and may involve the transition of patients from hospitalized to home or community-based treatment.