Multidrug-resistant Tuberculosis Burden among the New Tuberculosis Patients in Zhejiang Province: An Observational Study, 2009-2013

Patterns and trends of primary drug-resistant tuberculosis in Chongqing, China, from 2012 to 2020

Primary drug-resistant tuberculosis (DR-TB) contributes significantly to the global TB epidemic, particularly in countries with high TB burdens. This study aimed to investigate the characteristics of primary DR-TB prevalence in Chongqing, China, from 2012 to 2020. A total of 4546 newly diagnosed and 2769 relapse TB patients admitted to the hospital from 2012 to 2020 were included. Categorical variables were compared using Pearson chi-square test or Fisher exact test, as appropriate. Logistic regression analysis was performed to determine factors associated with primary DR-TB. The rate of primary DR-TB was 24.5%, whereas that of acquired DR-TB was 67.8%. Among newly diagnosed TB cases, the percentage of DR-TB (from 48.9 to 44.2%), mono-resistant TB (from 11.8 to 9.7%), multidrug-resistant TB (MDR-TB; from 25.3 to 6.9%), and pre-extensive drug-resistant TB (from 13.7 to 5.8%) showed a decreasing trend from 2012 to 2020. Age from 15 to 64 years was a risk factor for the development of primary DR-TB (15-44 years: adjusted odds ratio = 2.227, 95% confidence interval: 1.053-4.710; 45-64 years: adjusted odds ratio = 2.223, 95% confidence interval: 1.048-4.717). The rates of primary DR-TB (P = .041) and MDR-TB (P = .007) were significantly higher in the age group of 15 to 64 years than in the age groups of ≤14 years and ≥65 years. Noticeably, rising trends of primary DR-TB (from 0 to 27.3%) and MDR-TB (from 0 to 9.1%) in the population of ≤14 years were observed from 2012 to 2020. Although the rate of primary DR-TB showed a downward trend, a rising drug-resistance rate among some particular subgroups was still observed. Further control of primary DR-TB should focus more on TB patients aged 15 to 64 years.

Risk factors associated to multidrug-resistant tuberculosis in patients attending the deido district hospital of Douala - Cameroon

Background

Multidrug-resistant tuberculosis (MDR-TB) is defined as resistance to at least isoniazid and rifampicin. In Cameroon, the prevalence is estimated at 150 cases/100,000 inhabitants or 6000 cases out of an estimated population of 3 million.

Objective

The aim of the present study was to determine the risk factors associated with MDR-TB at Deido District Hospital located in the littoral region of Cameroon.

Methods

This was a cross-sectional and analytical retrospective study. Our sample included all TB patients undergoing treatment at the Diagnostic and Treatment Center of the hospital from January 2019 to August 2020. Identified risk factors of MDR-TB were analyzed using the SPSS software version 20.0.

Results

A total of 304 participants were enrolled with a predominance of 185 (60.8%) men. The average age was 35 years (29-43 years). About 122/304 (40%) of the patients suffered from MDR-TB. The significant factors associated with MDR-TB were occupation (adjusted odd ratio [aOR] = 61.46), monthly income (aOR = 0.11), history of TB (aOR = 5.3), alcohol consumption (aOR = 12.7); self-medication (aOR = 5.4) and consultation of traditional healers for any cure (aOR = 155.84).

Conclusion

The emergence of MDR-TB associated with several risk factors in the study area is worrisome and can be prevented by improving the living conditions of patients and putting in place appropriate treatment strategies.

Characteristics and Trend of Drug-Resistant Tuberculosis at a Major Specialized Hospital in Chongqing, China: 2016 Versus 2019

OBJECTIVE

The epidemic of drug-resistant tuberculosis (DR-TB) has become a major concern in global TB control. This study aimed to investigate the patterns and trend of DR-TB epidemic between different time periods in Chongqing.

METHODS

A total of 985 and 835 culture positive TB patients with drug susceptibility testing (DST) results admitted to the hospital in 2016 and 2019, respectively, were included. Chi-square testing was used to compare the prevalence and trends of DR-TB in 2016 and 2019.

RESULTS

The proportion of previously treated TB cases with culture positivity was 45.7% in 2019, significantly higher than that in 2016 (39.1%, P = 0.004). The overall rate of drug resistance in 2019 was 43.1%, higher than that in 2016 (40.2%). The rates of multi-drug resistant TB (MDR-TB) and pre-extensively drug resistant TB (pre-XDR-TB) increased significantly from 2016 to 2019 among all TB cases (MDR: 25% vs 33.4%, P < 0.001 and pre-XDR: 7.1% vs 12.8%, P < 0.001, respectively) and previously treated TB cases (MDR: 46.5% vs 56%, P = 0.008 and pre-XDR: 13.2% vs 21.5%, P = 0.003, respectively).

CONCLUSIONS

Our findings indicated that the prevalence of DR-TB remains high in Chongqing. The trend of resistance to anti-TB drugs beccame worse between 2016 and 2019. Moreover, acquired MDR may play a major role in MDR-TB epidemic in Chongqing. Therefore, rapid diagnosis and effective treatment of TB patients will be important to reduce the burden of DR-TB in Chongqing.

Gap to End-TB targets in eastern China: A joinpoint analysis from population-based notification data in Zhejiang Province, China, 2005-2018

BACKGROUND

Zhejiang is a southeastern province of China with middle level notification rates of tuberculosis in China, but more than 27,000 pulmonary tuberculosis (PTB) cases are still reported annually in this province. We aimed to analyze the time trends of PTB cases and bacteriologically confirmed cases notification rates at the province and city levels of Zhejiang during 2005-2018.

METHODS

Data from the web-based TB Information Management System of Zhejiang Province were used to calculate annual notification rates per 100,000 population of PTB cases and bacteriologically confirmed cases for Zhejiang Province and its 11 cities. The joinpoint regression method was used to analyze the time trends and calculate the annual percentage change of notification rates.

RESULTS

There were 480,668 notified PTB cases in Zhejiang Province during 2005-2018, 38.78% of which were bacteriologically confirmed cases. Both the PTB cases and bacteriologically confirmed cases notification rates of Zhejiang Province have declined since 2007. Most of the cities' time trends were the same as Zhejiang Province. The PTB cases and bacteriologically confirmed cases notification rates of males and elderly people are the highest in both sexes and among the four age groups, but the decline speeds of the two groups were slowest.

CONCLUSIONS

With the effective implementation of TB control measures and projects, the PTB cases notification rates of Zhejiang Province have declined. In order to reach the target in 2035 of the End TB Strategy, additional efforts should be made in the diagnosis and treatment of TB patients, particularly with regard to males and older adult people.

Longitudinal Analysis of Prevalence and Risk Factors of Rifampicin-Resistant Tuberculosis in Zhejiang, China

Objectives

To investigate the factors associated with rifampicin-resistant tuberculosis among drug resistant tuberculosis patients and to determine the correlation of rifampicin-resistant TB with MDR-TB in a high MDR-TB burden province of china.

Methods

A retrospective longitudinal analysis on four surveys of anti-TB drug resistance done in 1998, 2003, 2008, and 2013 in Zhejiang province, China. 4289 sputum-smear microscopy positive suspected tuberculosis patients were eligible at 30 investigation points, chosen by stratified random sampling at survey sites from all over the province. Culturing samples in L-J medium and the drug-susceptibility testing for the 4 first-line anti-TB drugs were performed to all patients. Multivariate logistic regression was carried out to determine the factors associated with the rifampicin-resistance in the study population.

Results

Overall, there were 3832 patients with positive mycobacterial cultures, and 2813 of the isolates (73.4%) were susceptible to all 4 first-line drugs. Analysis of rifampin monoresistant (RMR) TB indicated the prevalence was 1.1% in new cases and 3.4% in previously treated cases. Among the 359 rifampicin resistant TB (RR-TB) cases, 279 (77.7%) were also resistant to isoniazid, indicating MDR-TB. From 1998 to 2013, the proportion of MDR-TB among rifampicin-resistant TB cases varied between 80.0% and 87.5% (P for trend: 0.768) among previously treated cases and varied from 68.6% to 79.5% (P for trend: 0.403) among new cases. Among previously treated patients, those who received treatment for less than 6 months were less likely to have drug resistant TB (OR: 0.40, 95% CI: 0.16–0.97) or MDR-TB (OR: 0.24, 95% CI: 0.07–0.81). Patients who received anti-TB treatment in a general hospital were less likely to develop MDR-TB than those treated in a TB clinic (OR: 0.08, 95% CI: 0.01–0.72).

Conclusion

This study highlights a high proportion of RMR-TB among new RR-TB cases in Zhejiang, China. The management of treatment with rapid and accurate diagnosis of MDR-TB other than only relying on RIF susceptibility testing is crucial for improving adherence and outcomes in patients with drug-resistant TB.

Multi-drug resistant Mycobacterium tuberculosis in Port Harcourt, Nigeria

Background

In past years, much focus has been on tackling the scourge and spread of tuberculosis worldwide. The recent emergence of multi-drug resistant (MDR) tuberculosis has, however, negatively threatened progress made so far. Nigeria ranks fourth out of the 22 high tuberculosis burden countries in the world and has the highest burden of tuberculosis in Africa. It is therefore necessary to monitor the MDR tuberculosis situation in the country.

Objectives

This study set out to assess the proportions of MDR tuberculosis in patients attending six directly observed treatment short-course centres in Port Harcourt, Nigeria, from October 2015 to October 2016.

Methods

Six hundred and nine participants between the ages of 18 and 75 years were enrolled in this study and comprised suspected and newly diagnosed tuberculosis cases. Sputum samples obtained from the participants were screened for the presence of Mycobacterium tuberculosis using standard culture and phenotypic biochemical techniques, and drug susceptibility testing was carried out using the 1% proportion conventional method.

Results

Of the 609 participants enrolled, 30 (4.9%) were confirmed as M. tuberculosis-positive cases. A high prevalence of drug resistant tuberculosis was noted in this study (14/30, 46.7%), with 26.7% of isolates resistant to streptomycin. MDR tuberculosis, defined as being resistant to isoniazid and rifampicin, was detected in only one case (3.3%).

Conclusion

This study reports a low rate of MDR tuberculosis and contributes to the sparse data on drug resistant tuberculosis in Nigeria.