First-line drugs resistance of Mycobacterium tuberculosis isolated from inpatients and its influencing factors in the four provinces of northwestern China
LI Yu-qing1, WAN Li3, CHEN Xing1, LIU Hai-can2, JIANG Yi2, ZHAO Xiu-qin2, GUAN Cha-xiang3, WAN Kang-lin2, YUAN Xiu-qin1
1. School of Public Health, University of South China, Hengyang 421001, China; 2. State Key Laboratory for Infectious Diseases Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China; 3. Department of Physiology, Xiangya Medical School, Central South University, Changsha 410000, China
Abstract:In this study, we investigated the status of the first-line drugs resistance (DR) of Mycobacterium tuberculosis (MTB) and its influencing factors in the four provinces of northwestern China to provide basic scientific evidence for the prevention and control of drug-resistant tuberculosis (TB). A total of 757 clinical MTB isolates from the sputum specimens of the patients with TB in 2005-2011 from four provinces and the autonomous regions (Gansu, Tibet, Xinjiang, Inner Mongolia) of Northwest China were collected. The drug susceptibility of these clinical isolates to the four first-line drugs streptomycin (SM), rifampicin (RFP), isoniazid (INH) and ethambutol (EMB) was determined by means of the drug susceptibility test (DST) of proportion method. The related influencing factors of DR-TB were analyzed by χ2 analysis with case background data. Of 757 clinical MTB isolates tested with DST, the percentages of drug resistance to SM, RFP, INH and EMB were 28.14%, 26.68%, 26.02% and 7.53%, and the total drug resistance rate and multi-drug resistance (MDR) rate were 40.55% and 18.63%, respectively. The total drug resistance rate and MDR rate of Tibet, Xinjiang, Gansu and Inner Mongolia were 64.42% and 42.94%, 40.48% and 23.81%, 41.61% and 3.36%, 27.90% and 11.29%, respectively. The statistical χ2 analysis results showed that there were significant differences in drug resistance rate to RFP, INH and SM and MDR rate in these provinces (P<0.05). Logistic regression analysis results showed that the influence factors were the case types. The risk of drug resistance in retreatment cases was 2.582 times (95%CI: 1.882-3.737) than that in the initial treatment cases. The status of MDR is serious in the northwestern China, especially in Tibet and Xinjiang. Strengthening surveillance of drug resistance and standardized and whole course treatment of TB to prevent the disease recurrence are the key measures for the better prevention and control of drug resistant TB.
李雨晴, 万李, 陈杏, 刘海灿, 蒋毅, 赵秀芹, 管茶香, 万康林, 袁秀琴. 中国西北四省(区)结核分枝杆菌分离株一线药物耐药状况及其影响因素分析[J]. 中国人兽共患病学报, 2017, 33(5): 398-402.
LI Yu-qing, WAN Li, CHEN Xing, LIU Hai-can, JIANG Yi, ZHAO Xiu-qin, GUAN Cha-xiang, WAN Kang-lin, YUAN Xiu-qin. First-line drugs resistance of Mycobacterium tuberculosis isolated from inpatients and its influencing factors in the four provinces of northwestern China. Chinese Journal of Zoonoses, 2017, 33(5): 398-402.
[1] WHO. Global tuberculosis report, 2015[EB/OL]. (2016-08-23)[2016-12-01]. http://apps.who.int/iris/bitstream/10665/191102/1/9789241565059_eng.pdf?ua=1. [2] Technical Guidance Group of the Fifth National TB Epidemiological Survey, The Office of the Fifth National TB Epidemiological Survey. The fifth national tuberculosis epidemiological survey in 2010[J]. Chin J Anti-tuberculosis, 2012, 34(8): 485-508. (in Chinese) 全国第五次结核病流行病学抽样调查技术指导组, 全国第五次结核病流行病学抽样调查办公室. 2010年全国第五次结核病流行病学抽样调查报告[J]. 中国防痨杂志, 2012, 34(8): 485-508. [3] Li ZN, Liu M, Lyu B, et al. Comparison on discriminatory power of different variable number tandem repeats locus-set on genotyping of Mycobacterium tuberculosis isolated in China[J]. Chin J Pevent Med, 2009, 43(3): 215-222. (in Chinese) 李兆娜, 刘梅, 吕冰, 等. 不同串联重复序列位点组合用于中国结核分枝杆菌基因分型的能力比较分析[J]. 中华预防医学杂志, 2009, 43(3): 215-222. [4] The basis speciality Committee on bas science of Chinese Anti-tuberculosis Association. The Laboratory Science Procedure of Diagnostic Bacteriology in Tuberculosis[M]. Beijing: Chinese Education Culture Press, 2006: 46-51. (in Chinese) 中国防痨协会基础专业委员会. 结核病诊断实验室检验规程[M].北京:中国教育文化出版社, 2006: 46-51. [5] Wang FY, Zhang L. Progress in the mechanism of Mycobacterium tuberculosis evasion from the immune killing[J]. Chin J Zoonoses, 2015, 31(6): 579-582. (in Chinese) 王飞雨, 章乐. 结核分枝杆菌逃逸免疫杀伤机制的研究进展[J]. 中国人兽共患病学报, 2015, 31(6): 579-582. [6] Hu ZQ, Liu YW, Zhou W, et al. Relationship between rpoB mutations and the levels of rifampicin resistance in M.tuberculosis [J]. Chin J Zoonoses, 2016, 32(1): 39-44. (in Chinese) 胡族琼, 刘燕文, 周文, 等. 结核分枝杆菌 rpoB 基因突变特征与利福平耐药水平关系的研究[J]. 中国人兽共患病学报, 2016, 32(1): 39-44. [7] Song Y, Wan L, Chen SS, et al. Analysis on drug resistance of Mycobacterium tuberculosis and influencing factors in six provinces of China[J]. Chin J Epidemiol, 2016, 37(7): 945-948. (in Chinese) 宋艺, 万李, 陈双双, 等. 中国6个省份结核分枝杆菌耐药状况及影响因素分析[J]. 中华流行病学杂志, 2016, 37(7): 945-948. [8] Pang H, Tong J, Liu HC, et al. Molecular characterization and drug-resistance of Mycobacterium tuberculosis strains in Xuzhou, China[J]. Biomed Environ Sci, 2014, 27(12): 960-964. doi:10.3967/bes2014.136 [9] Lisdawati V, Puspandari N, Rif’Ati L, et al. Molecular epidemiology study of Mycobacterium tuberculosis and its susceptibility to anti-tuberculosis drugs in Indonesia[J]. BMC Infect Dis, 2015, 15(1): 1-8. doi:10.1186/s12879-015-1101-y [10] He GX, Zhao YL, Jiang GL, et al. Prevalence of tuberculosis drug resistance in 10 provinces of China[J]. BMC Infect Dis, 2008, 8: 166. doi:10.1186/1471-2334-8-166 [11] Zhao LL, Chen Y, Chen ZN, et al. Prevalence and molecular characteristics of drug-resistant Mycobacterium tuberculosis in Hunan, China[J]. Antimicrob Agents Chemother, 2014, 58(6): 3475-3480. doi:10.1128/AAC.02426-14 [12] Espinal MA, Laserson K, Camacho M, et al. Determinants of drug-resistant tuberculosis: analysis of 11 countries[J]. Int J Tuberc Lung Dis, 2001, 5(10): 887-893. [13] Lomtadze N, Aspindzelashvili R, Janjgava M, et al. Prevalence and risk factors for multidrug-resistant tuberculosis in the Republic of Georgia: a population-based study[J]. Int J Tuberc Lung Dis, 2009, 13(1): 68-73. [14] Diande S, Sangare L, Kouanda S, et al. Risk factors for multidrug-resistant tuberculosis in four centers in Burkina Faso, West Africa[J]. Microb Drug Resist, 2009, 15(3): 217-221. doi:10.1089/mdr.2009.0906 [15] Su R, Ou WZ, Wang Y, et al. Detection of mutations associated with streptomycin and ethambutol resistance in Mycobacterium tuberculosis clinical isolates[J]. Chin J Zoonoses, 2016, 32 (8): 760-764. (in Chinese) 孙荣, 欧维正, 王燕, 等. 贵阳市结核分枝杆菌链霉素和乙胺丁醇耐药相关基因突变的检测与分析[J]. 中国人兽共患病学报, 2016, 32(8): 760-764. [16] Zhang Y, Hou SY, Yang CF, et al. Multi-drug resistant tuberculosis (TB) risk factor logistic regression analysis[J]. Chin J Health Statistics, 2013, (02): 190-191. (in Chinese) 张玉, 侯双翼, 杨成凤, 等. 耐多药结核病危险因素logistic回归分析[J]. 中国卫生统计, 2013 (02): 190-191. [17] Wang XY, Zhao YL, Pang Y, et al. Genotyping and drug resistance analysis of M. tuberculosis clinical isolates in Chongqing[J]. Chin J Antituberc, 2013, (09): 668-672. (in Chinese) 汪晓艳, 赵雁林, 逄宇, 等. 重庆市结核分枝杆菌临床分离株的基因分型及相关耐药性分析[J]. 中国防痨杂志, 2013 (09): 668-672.