Profile and influencing factors of drug resistance of Mycobacterium tuberculosis in smearpositive pulmonary tuberculosis patients in Hunan Province

Abstract:

ObjectiveTo investigate status and risk factors of drug resistance of smearpositive pulmonary tuberculosis (TB) patients in Hunan Province, and provide reference for the prevention and control of drugresistant TB.Methods1 935 Mycobacterium tuberculosis (MT) complex strains identified by 20 TB prevention and control institutes in Hunan Province between 2012 and 2014 were collected and performed drug susceptibility testing，and influencing factors associated with drug resistance of TB were analyzed statistically.ResultsOf 1 935 MT complex strains, 1 207 （62.38%）were sensitive to 6 kinds of antituberculosis drugs, 728 were drugresistant strains, overall drug resistance rate was 37.62%；467 (24.13%) were multidrugresistant (MDR) strains, 64 of which were extensively drugresistant (XDR) strains, XDR rate was 3.31%, resistance rates from high to low were as follows: isoniazid（INH）29.32%, rifampicin(RFP) 25.84%, streptomycin（SM）20.73%,thambutol（EMB）9.00%, ofloxacin（OFX）7.83%, and kanamycin（KM）2.21%. Multivariate logistic regression analysis showed that patients having a history of treatment, aged 20-39 and 40-60 years old were risk factors for drug resistance and MDR of pulmonary TB. Among patients who failed in retreatment, OR (95% CI) of resistance to INH, RFP, SM, EMB, OFX, KM, and MDR were 13.5(9.9-18.4), 21.2(15.2-29.5), 5.3(3.9-7.2),11.9(7.6-18.7), 7.6(4.6-12.6), 7.9(3.6-17.5), and 25.0(17.7-35.1) respectively; among patients who had recurrence, OR(95% CI) of resistance to INH, RFP, SM, EMB, OFX, and MDR were 7.4(5.5-10.0), 10.3(7.4-14.2), 3.5(2.5-4.8), 7.3(4.5-11.9), 4.1(2.5-6.8), and 12.2(8.7-17.1) respectively；among patients who failed in initial treatment, OR (95% CI) of resistance to INH,RFP,SM,EMB, and MDR were 7.6(4.7-12.3), 9.8(5.9-16.0), 4.1(2.5-6.8), 12.1(6.5-22.7), and 11.4(6.9-18.9) respectively. Among patients aged 20-39 years old, OR (95% CI) of resistance to INH,RFP,SM, and MDR were 2.5(1.8-3.4), 3.6(2.5-5.2), 2.9（2.0-4.1）, and 4.1（2.8-6.1） respectively；among patients aged 40-60 years old, the OR(95% CI) of resistance to INH,RFP,SM, and MDR were 2.2(1.6-3.0),3.1(2.2-4.4),2.3（1.6-3.2）, and 3.3（2.3-4.7）respectively.ConclusionDrug resistance of smearpositive pulmonary TB patients is serious in Hunan Province, patients receiving antituberculosis treatment and aged between 20-60 years old have high risk for drug resistance and MDR.