Profile and influencing factors of drug resistance of Mycobacterium tuberculosis in smear-positive pulmonary tuberculosis patients in Hunan Province / 中国感染控制杂志

ABSTRACT

Objective To investigate status and risk factors of drug resistance of smear-positive pulmonary tuber-culosis (TB)patients in Hunan Province,and provide reference for the prevention and control of drug-resistant TB. Methods 1 935 Mycobacterium tuberculosis (MT)complex strains identified by 20 TB prevention and control insti-tutes in Hunan Province between 2012 and 2014 were collected and performed drug susceptibility testing,and influ-encing factors associated with drug resistance of TB were analyzed statistically.Results Of 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 exten-sively drug-resistant (XDR)strains,XDR rate was 3.31 %,resistance rates from high to low were as followsisoniazid(INH)29.32%,rifampicin(RFP)25.84%,streptomycin(SM)20.73%,thambutol(EMB)9.00%,ofloxa-cin(OFX)7.83%,and kanamycin(KM)2.21 %.Multivariate logistic regression analysis showed that patients hav-ing a history of treatment,aged 20-39 and 40-60 years old were risk factors for drug resistance and MDR of pul-monary 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. Conclusion Drug resistance of smear-positive pulmonary TB patients is serious in Hunan Province,patients receiv-ing anti-tuberculosis treatment and aged between 20-60 years old have high risk for drug resistance and MDR.