Analysis of features of drug resistance and risk factors of multidrug-resistant tuberculosis in pulmonary tuberculosis patients in Songjiang District of Shanghai

doi:10.19983/j.issn.2096-8493.20210109

Abstract

Abstract: Objective: To analyze the drug resistance and risk factors of multidrug-resistant tuberculosis (MDR-TB) in patients with pulmonary tuberculosis in Songjiang District of Shanghai. Methods: A retrospective study was conducted in 1513 pulmonary tuberculosis patients diagnosed as Mycobacterium tuberculosis in the Songjiang District Central Hospital from 2012 to 2018. Data of the patients were collected from “Tuberculosis Information Management System”, and “First registration of pulmonary tuberculosis patients” and “Mycobacterium tuberculosis culture and drug sensitivity registration”of Songjiang District Central Hospital. Mycobacteriu tuberculosis resistance to first-line anti-TB drugs and risk factors for mutidrug-resistance tuberculosis were analyzed. Results: The overall drug resistance rate of 1513 pulmonary tuberculosis patients was 19.50% (295/1513), and the multidrug-resistance rate was 4.30% (65/1513). The drug resistance rates to the four first-line anti-tuberculosis drugswere streptomycin (Sm, 14.34%, 217/1513), isoniazid (INH, 10.38%,157/1513), rifampicin (RFP, 5.29%, 80/1513) and ethambutol (EMB, 3.83%,58/1513). The overall drug resistance rate, multidrug-resistance rates and poly-restance rate of newly treated patients were significant lower than those of relapse patients (18.46% (261/1414) vs. 34.34% (34/99), χ ²=14.874; 3.54% (50/1414) vs. 15.15% (15/99),χ²=30.361; 3.54% (50/1414) vs. 13.13% (13/99),χ²=21.347, respectively; all P=0.000). Multivariate logistic regression analysis showed that occupation as workers (OR=2.078, 95%CI=1.196-3.609) and retreatment (OR=5.195, 95%CI=2.782-9.700) were risk factors for MDR-TB. Conclusions: The rates of drug resistance and multidrug-resistance in Songjiang District of Shanghai was low. However, drug resistance screening should be actively carried out for key groups such as retreated patients and worker, and attention should be paid to the monitoring of drug resistance in newly diagnosed patients, to control the occurrence of MDR-TB.

Key words: Tuberculosis, pulmonary, Drug resistance, multiple, Factor analysis, statistical

CLC Number:

LI Yong, LU Li-ping, LI Jin, ZOU Jin-yan. Analysis of features of drug resistance and risk factors of multidrug-resistant tuberculosis in pulmonary tuberculosis patients in Songjiang District of Shanghai[J]. Journal of Tuberculosis and Lung Disease , 2022, 3(2): 142-147. doi: 10.19983/j.issn.2096-8493.20210109

Figures/Tables 4

References 22

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耐药类型	初治(1414例)		复治(99例)		合计(1513例)		χ² 值		P值
耐药类型	例数	耐药率(%)	例数	耐药率(%)	例数	耐药率(%)	χ² 值		P值
任一药物耐药	261	18.46	34	34.34	295	19.50	14.874	0.000
INH	129	9.12	28	28.28	157	10.38
RFP	62	4.38	18	18.18	80	5.29
Sm	191	13.51	26	26.26	217	14.34
EMB	42	2.97	16	16.16	58	3.83
单耐药	161	11.39	6	6.06	167	11.04	2.672	0.102
INH	35	2.48	2	2.02	37	2.45
RFP	7	0.50	1	1.01	8	0.53
Sm	114	8.06	3	3.03	117	7.73
EMB	5	0.35	0	0.00	5	0.33
耐多药	50	3.54	15	15.15	65	4.30	30.361	0.000
INH+RFP	7	0.50	2	2.02	9	0.59
INH+RFP+Sm	15	1.06	3	3.03	18	1.19
INH+RFP+EMB	11	0.78	2	2.02	13	0.86
INH+RFP+Sm+EMB	17	1.20	8	8.08	25	1.65
多耐药	50	3.54	13	13.13	63	4.16	21.347	0.000
INH+Sm	40	2.83	6	6.06	46	3.04
INH+EMB	1	0.07	0	0.00	1	0.07
RFP+Sm	1	0.07	1	1.01	2	0.13
RFP+EMB	4	0.28	1	1.01	5	0.33
Sm+EMB	1	0.07	0	0.00	1	0.07
INH+Sm+EMB	3	0.21	5	5.05	8	0.53
RFP+Sm+EMB	0	0.00	0	0.00	0	0.00

影响因素		耐多药(65例)				全敏感(1218例)				χ² 值	P值
影响因素		例数		构成比(%)		例数		构成比(%)		χ² 值	P值
性别										1.566	0.211
男性		50		76.92		848		69.62
女性		15		23.08		370		30.38
年龄组(岁)										2.781	0.095
<60		59		90.77		1009		82.84
≥60		6		9.23		209		17.16
职业									6.153		0.013
工人	46		70.77		671		55.09
非工人	19		29.23		547		44.91
户籍									1.453		0.228
本市	13		20.00		326		26.77
外省市	52		80.00		892		73.23
居住地区									1.221		0.269
城区	23		35.38		353		28.98
乡镇	42		64.62		865		71.02
吸烟史									0.730		0.393
有	26		40.00		424		34.81
无	39		60.00		794		65.19
饮酒史									0.241		0.623
有	22		33.85		377		30.95
无	43		66.15		841		69.05
患者类型									33.217		0.000
初治	50		76.92		1153		94.66
复治	15		23.08		65		5.34
并发空洞									0.706		0.401
有	22		33.85		353		28.98
无	43		66.15		865		71.02
痰涂片结果									0.430		0.512
阳性	35		53.85		605		49.67
阴性	30		46.15		613		50.33
合并糖尿病									2.332		0.127
是	5		7.69		47		3.86
否	60		92.31		1171		96.14
发生药物性肝损伤									1.262		0.261
是	7		10.77		86		7.06
否	58		89.23		1132		92.94
是否规律抗结核治疗									4.257		0.039
是	58		89.23		1158		95.07
否	7		10.77		60		4.93

变量	赋值
是否为工人	是=1;否=2
患者类型	初治=1;复治=2
是否规律抗结核治疗	是=1;否=2

影响因素	β值	s$\bar{x}$值	Wald χ² 值	P值	OR值	95%CI值
工人	0.745	0.282	6.972	0.008	2.078	1.196~3.609
复治	1.631	0.320	25.987	0.000	5.195	2.782~9.700
规律抗结核治疗	0.826	0.430	3.689	0.055	0.438	0.189~1.017