Analysis of features of drug resistance of Mycobacterium tuberculosis and risk factors of multidrug-resistance in Hinggan League of Inner Mongolia Autonomous Region, 2021—2023

doi:10.19983/j.issn.2096-8493.2024124

Abstract

Abstract:

Objective: To analyze the drug resistance of Mycobacterium tuberculosis and risk factors of multidrug-resistance in Hinggan League, Inner Mongolia from 2021 to 2023, and provide scientific evidence for preventing the occurrence and prevalence of drug-resistant tuberculosis in Hinggan League. Methods: The registration information of 615 culture positive patients in six counties (banners) of Hinggan League from January 1st, 2021 to December 30th, 2023 were collected from China National Notifiable Infectious Disease Reporting Information System, and the drug susceptibility tests of 615 strains of Mycobacterium tuberculosis to 16 anti-tuberculosis drugs were carried out using the microplate method and the influencing factors of multi-drug resistance of tuberculosis patients were analyzed using the logistic regression model. Results: (1) The drug susceptibility test results showed that the higher resistance rates to 16 anti-tuberculosis drugs were INH (13.01%, 80/615), Sm (11.71%, 72/615), Km (6.99%, 43/615), Cs (6.18%, 38/615), and RFP (5.37%, 33/615). There were statistically significant differences in the resistance rates of RFP, Km, Rfb, PAS, and PAS-INH (4.22% (20/474) and 9.22% (13/141), 5.49% (26/474) and 12.06% (17/141), 1.05% (5/474) and 4.26% (6/141), 1.69% (8/474) and 5.67% (8/141), 1.05% (5/474) and 4.26% (6/141)) between initial and retreatment patients (χ²=5.351,P=0.021;χ²=7.217,P=0.007;χ²=4.646,P=0.031;χ²=5.332,P=0.021;χ²=4.646,P=0.031). (2) There were 198 drug-resistant strains among 615 strains, with a overall drug resistance rate of 32.20% (198/615), RFP resistance rate of 2.28% (14/615), Mono-drug resistance rate of 20.33% (125/615), poly-resistance rate of 8.78% (54/615), multidrug-resistance rate of 3.09% (19/615). The drug resistance spectrum of the sixteen anti-tuberculosis drugs consisted of 46 different types of drug resistance, including 9 types of mono-drug resistance, 24 types of poly-resistance, 9 types of multidrug-resistance (not including pre-extensive drug resistance), and 4 types of extensive drug resistance.The poly-resistance rate (15.60%, 22/141) in retreatment patients was higher than that in initial patients (6.75%, 32/474)(χ²=10.631, P=0.001). (3) Retreated tuberculosis patients and key populations were risk factors for MDR-TB (OR=3.232, 95%CI: 1.187-8.805;OR=3.388, 95%CI: 1.211-9.479), and direct medical treatment was a protective effect against MDR-TB (OR=0.196, 95%CI: 0.043-0.885). Conclusion: From 2021 to 2023, the drug resistance spectrum presented complexity and diversity in Hinggan League. The treatment history, whether it was a key population, and the source of patients were the influencing factors of drug resistance.

Key words: Mycobacterium tuberculosis, Tuberculosis, multidrug-resistant, Factor analysis, statistical, Hinggan League

CLC Number:

R211
R521

Sun Bo, Feng Liping, Teng Chong, Zhu Hanfang, Zhao Bing, Feng Tao, Wang Qingkui, Zhou Hao, Gao Xinghai, Ou Xichao. Analysis of features of drug resistance of Mycobacterium tuberculosis and risk factors of multidrug-resistance in Hinggan League of Inner Mongolia Autonomous Region, 2021—2023[J]. Journal of Tuberculosis and Lung Disease , 2024, 5(5): 437-444. doi: 10.19983/j.issn.2096-8493.2024124

Figures/Tables 6

References 24

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特征	初治(474例)	复治(141例)	合计(615例)	χ²值	P值
性别				0.130	0.718
男性	356(75.11)	108(76.60)	464(75.45)
女性	118(24.89)	33(23.40)	151(24.55)
年龄组(岁)				5.130	0.163
0~19	7(1.48)	1(0.71)	8(1.30)
20~39	108(22.78)	21(14.89)	129(20.98)
40~59	225(47.47)	71(50.36)	296(48.13)
≥60	134(28.27)	48(34.04)	182(29.59)
民族				0.153	0.926
蒙古族	227(47.89)	66(46.81)	293(47.64)
汉族	239(50.42)	72(51.06)	311(50.57)
其他^a	8(1.69)	3(2.13)	11(1.79)
职业				7.630	0.006
农民	319(67.30)	112(79.43)	431(70.08)
非农民	155(32.70)	29(20.57)	184(29.92)
居住地				7.660	0.006
城镇	120(25.32)	20(14.18)	140(22.76)
乡村	354(74.68)	121(85.82)	475(77.24)

药物	初治(474株)		复治(141株)		合计(615株)		χ²值	P值
药物	菌株数	耐药率(%)	菌株数	耐药率(%)	菌株数	耐药率(%)	χ²值	P值
RFP	20	4.22	13	9.23	33	5.37	5.351	0.021
INH	55	11.60	25	17.73	80	13.01	3.605	0.058
EMB	5	1.05	2	1.42	7	1.14	<0.001	>0.999^a
Km	26	5.49	17	12.06	43	6.99	7.217	0.007
Am	3	0.63	2	1.42	5	0.81	0.143	0.706^a
Lfx	4	0.84	1	0.71	5	0.81	<0.001	>0.999^a
Mfx	5	1.05	2	1.42	7	1.14	<0.001	>0.999^a
Lzd	5	1.05	0	0.00	5	0.81	0.477	0.490
Cfz	3	0.63	2	1.42	5	0.81	0.143	0.706^a
Sm	50	10.55	22	15.60	72	11.71	2.686	0.101
Rfb	5	1.05	6	4.26	11	1.79	4.646	0.031
PAS	8	1.69	8	5.67	16	2.60	5.332	0.021
PAS-INH	5	1.05	6	4.26	11	1.79	4.646	0.031
Cs	30	6.33	8	5.67	38	6.18	0.081	0.777
Cm	2	0.42	2	1.42	4	0.65	-	0.227^b
Pto	1	0.21	1	0.71	2	0.33	-	0.406^b

耐药谱	初治(474株)		复治(141株)		合计(615株)		χ²值	P值
耐药谱	菌株数	耐药率(%)	菌株数	耐药率(%)	菌株数	耐药率(%)	χ²值	P值
单一耐药	99	20.89	26	18.44	125	20.33	0.402	0.526
耐多药(包括原准广泛耐药)	11	2.32	8	5.67	19	3.09	4.081	0.053^a
多耐药	32	6.75	22	15.60	54	8.78	10.631	0.001

因素		合计 (株)		敏感[株,构成比(%)]	耐药[株,构成比(%)]		χ²值		P值		耐多药[株, 率(%)]		χ²值		P值		多耐药[株, 率(%)]		χ²值		P值
性别							2.331		0.127				-		0.796^a				-		0.869^a
男性		464		307(66.16)	157(33.84)						15(3.23)						40(8.62)
女性		151		110(72.85)	41(27.15)						4(2.65)						14(9.27)
治疗史							4.741		0.029				-		0.053^a				10.631		0.001
初治		474		332(70.04)	142(29.96)						11(2.32)						32(6.75)
复治		141		85(60.28)	56(39.72)						8(5.76)						22(15.60)
年龄组(岁)							2.568		0.463				-		0.239^a				-		0.002^a
0~19		8		6(75.00)	2(25.00)						1(12.50)						0(0.00)
20~39		129		87(67.44)	42(32.56)						2(1.55)						8(6.20)
40~59		296		193(65.20)	103(34.80)						11(3.72)						3(1.01)
≥60		182		131(71.98)	51(28.02)						5(2.75)						13(7.14)
居住地区							1.028		0.311				-		>0.999^a				0.846		0.395
城镇		140		90(64.29)	50(35.71)						4(2.86)						15(10.71)
乡村		475		327(68.84)	148(31.12)						15(3.16)						39(8.21)
职业							0.002		0.964				0.448		0.503				1.431		0.232
农民		431		292(67.75)	139(32.25)						12(2.78)						34(7.89)
非农民		184		125(67.93)	59(32.07)						7(3.80)						20(10.87)
重点人群^b							0.907		0.341				-		0.016^a				0.980		0.322
是		117		75(64.10)	42(35.90)						8(6.84)						13(11.11)
否		498		342(68.67)	156(31.33)						11(2.21)						41(8.23)
患者来源								6.193		0.103				-		0.106^a				-	0.335^a
直接就诊	255		175(68.63)			80(31.37)						6(2.35)						27(10.59)
转诊	44		25(56.82)			19(43.18)						2(4.55)						3(6.82)
追踪	286		201(70.28)			85(29.72)						8(2.80)						20(6.99)
其他^c	30		16(53.33)			14(46.67)						3(9.68)						4(12.90)

变量	赋值	变量	赋值
性别	男=1;女=0	职业	农民=0;非农民=1
治疗史	初治=0;复治=1	重点人群	是=0;否=1
年龄组(岁)	0~19岁=1;20~39岁=2;40~59岁=3;≥60岁=4	患者来源	直接就诊=1;转诊=2;追踪=3;其他=4
居住地区	城镇=0;乡村=1	民族	蒙古族及其他少数民族=0;汉族=1