Analysis of drug resistance of tuberculosis patients in Dalian from 2012 to 2018

doi:10.3969/j.issn.2095-3755.2019.04.007

Abstract

Abstract:

Objective To analyze the drug resistance of tuberculosis (TB) in Dalian from 2012 to 2018.Methods Based on China Information System of Disease Prevention and Control, a total of 5512 TB patients newly registered with smear-positive and sputum culture (modified Roche culture method) were collected from TB Information Management System in Dalian from 2012 to 2018. Among these patients, 5241 (95.1%) patients with positive culture were subjected to strain identification and anti-TB drugs sensitivity test (referred to as “drug susceptibility test”). Finally, 5050 strains of Mycobacterium tuberculosis (MTB) (96.4%, 5050/5241) and 191 strains of non-tuberculosis mycobacteria (NTM) (3.6%, 191/5241) were obtained. The drug resistance of the strain identified as MTB was analyzed based on drug susceptibility test results. SPSS 12.0 software was used to conduct Chi-square test or Chi-square trend test on the counting data or the annual drug resistance rate, and the linear regression equation was used to verify the drug resistance rate, multidrug resistance rate, year and the situation of the initial treatment or the retreatment. P<0.05 was considered as a statistically significant difference.Results The total drug resistant rate, total multidrug resistant rate, drug resistant rate of the initial treatment, multidrug resistant rate of the initial treatment, resistant rate of the retreatment, and multidrug resistant rate of the retreatment in Dalian were, respectively, 64.5% (223/346), 34.7% (120/346), 46.6% (34/73), 23.3% (17/73), 69.2% (189/273), and 37.7% (103/273) in 2012, while which were dropped to 24.0% (176/733), 6.7% (49/733), 19.0% (99/522), 4.8% (25/522), 36.5% (77/211), and 11.4% (24/211) in 2018, showing a significant downward trend ( $χ trend 2$ =213.930, 223.357, 40.371, 49.536, 86.323, 66.990, all P values =0.000). The results of the linear regression equation showed that the total drug resistant rate, year and the condition of initial treatment and retreatment showed a decreasing trend (P_resistance=0.000, P_{multidrug resistance}=0.000). The total resistant rate of the 5050 strains to INH, RFP, Sm, Ofx, Km, EMB were, respectively, 19.2% (970/5050), 17.8% (900/5050), 8.9% (447/5050), 10.3% (521/5050), 4.8% (243/5050), and 2.5% (124/5050). There were 46 combinations of drug resistance in 1623 strains, including 6 kinds of single drug resistance, accounting for 45.3% (735/1623) of the total drug resistance spectrum, with the highest INH resistance (13.3%, 216/1623); 16 kinds of multidrug resistance (including extensive drug resistance), accounting for 36.8% (598/1623) of the total drug resistance spectrum, with the highest resistance to INH + RFP (13.3%, 216/1623); 24 kinds of multidrug resistance, accounting for 17.9% (290/1623) of the total drug resistance spectrum, with the highest resistance to INH + Sm (4.0%, 65/1623).Conclusion From 2012 to 2018, the total drug resistance rate and the total multidrug resistance rate of TB showed a significant downward trend in Dalian. The treatment and management of MDR-TB system exerts the remarkable prevention and control effects.

Key words: Tuberculosis,pulmonary, Microbial sensitivity tests, Tuberculosis,multidrug-resistant, Data interpretation,statistical, Small-area analysis

Chun-kui CAI,Xin-tong LYU,Gang LI,Shi-xue SUN,Xiao-feng GU,Yan XU,Ying WANG,Yang YU,Xi-wei LU. Analysis of drug resistance of tuberculosis patients in Dalian from 2012 to 2018[J]. Journal of Tuberculosis and Lung Health , 2019, 8(4): 265-271. doi: 10.3969/j.issn.2095-3755.2019.04.007

Figures/Tables 5

年份	初治			复治			合计			χ²值^a	P值	χ²值^b	P值
年份	菌株株数	耐药 [株 (率,%)]	耐多药[株 (率,%)]	菌株株数	耐药[株 (率,%)]	耐多药[株 (率,%)]	菌株株数	耐药[株 (率,%)]	耐多药[株 (率,%)]	χ²值^a	P值	χ²值^b	P值
2012	73	34(46.6)	17(23.3)	273	189(69.2)	103(37.7)	346	223(64.5)	120(34.7)	12.903	0.000	5.303	0.021
2013	456	124(27.2)	47(10.3)	181	99(54.7)	55(30.4)	637	223(35.0)	102(16.0)	43.077	0.000	38.846	0.000
2014	642	191(29.8)	51(8.0)	217	115(53.0)	56(25.8)	859	306(35.6)	107(12.5)	38.211	0.000	47.454	0.000
2015	668	171(25.6)	42(6.3)	219	82(37.4)	38(17.4)	887	253(28.5)	80(9.0)	11.349	0.001	24.605	0.000
2016	592	132(22.3)	31(5.2)	241	97(40.2)	45(18.7)	833	229(27.5)	76(9.1)	27.690	0.000	37.290	0.000
2017	538	125(23.2)	27(5.0)	217	88(40.6)	37(17.1)	755	213(28.2)	64(8.5)	22.901	0.000	28.855	0.000
2018	522	99(19.0)	25(4.8)	211	77(36.5)	24(11.4)	733	176(24.0)	49(6.7)	25.300	0.000	10.446	0.001
合计	3491	876(25.1)	240(6.9)	1559	747(47.9)	358(23.0)	5050	1623(32.1)	598(11.8)	257.378	0.000	263.739	0.000
$χ 趋势 2$ 值		40.371	49.536		86.323	66.990		213.930	223.357
P值		0.000	0.000		0.000	0.000		0.000	0.000

年份	菌株数	对一线抗结核药物耐药				对二线抗结核药物耐药
年份	菌株数	INH[株(率,%)]	RFP[株(率,%)]	EMB[株(率,%)]	Sm[株(率,%)]	Ofx[株(率,%)]	Km[株(率,%)]
2012	346	145(41.9)	175(50.6)	1(0.3)	1(0.3)	109(31.5)	53(15.3)
2013	637	150(23.5)	156(24.5)	3(0.5)	5(0.8)	78(12.2)	68(10.7)
2014	859	191(22.2)	149(17.3)	31(3.6)	89(10.4)	97(11.3)	53(6.2)
2015	887	129(14.5)	127(14.3)	12(1.4)	109(12.3)	58(6.5)	29(3.3)
2016	833	133(16.0)	117(14.0)	19(2.3)	89(10.7)	65(7.8)	13(1.6)
2017	755	120(15.9)	94(12.5)	30(4.0)	75(9.9)	62(8.2)	17(2.3)
2018	733	102(13.9)	82(11.2)	28(3.8)	79(10.8)	52(7.1)	10(1.4)
合计	5050	970(19.2)	900(17.8)	124(2.5)	447(8.9)	521(10.3)	243(4.8)
$χ 趋势 2$ 值		164.339	325.411	39.595	106.166	202.507	188.304
P值		0.000	0.000	0.042	0.000	0.016	0.000

年份	菌株数	对一线抗结核药物耐药				对二线抗结核药物耐药
年份	菌株数	INH[株(率,%)]	RFP[株(率,%)]	EMB[株(率,%)]	Sm[株(率,%)]	Ofx[株(率,%)]	Km[株(率,%)]
2012	73	21(28.8)	25(34.2)	0(0.0)	0(0.0)	14(19.2)	12(16.4)
2013	456	80(17.5)	76(16.7)	1(0.2)	1(0.2)	42(9.2)	43(9.4)
2014	642	114(17.8)	74(11.5)	15(2.3)	58(9.0)	58(9.0)	44(6.9)
2015	668	80(12.0)	67(10.0)	11(1.6)	77(11.5)	41(6.1)	22(3.3)
2016	592	65(11.0)	56(9.5)	8(1.4)	54(9.1)	32(5.4)	7(1.2)
2017	538	61(11.3)	41(7.6)	15(2.8)	50(9.3)	39(7.2)	10(1.8)
2018	522	54(10.3)	38(7.3)	10(1.9)	54(10.3)	26(5.0)	1(0.2)
合计	3491	475(13.6)	377(10.8)	60(1.7)	294(8.4)	252(7.2)	139(4.0)
$χ 趋势 2$ 值		27.740	30.895	11.507	62.856	13.960	93.546
P值		0.000	0.000	0.042	0.000	0.016	0.000

年份	菌株数	对一线抗结核药物耐药				对二线抗结核药物耐药
年份	菌株数	INH[株(率,%)]	RFP[株(率,%)]	EMB[株(率,%)]	Sm[株(率,%)]	Ofx[株(率,%)]	Km[株(率,%)]
2012	273	124(45.4)	150(54.9)	1(0.4)	1(0.4)	95(34.8)	41(15.0)
2013	181	70(38.7)	80(44.2)	2(1.1)	4(2.2)	36(19.9)	25(13.8)
2014	217	77(35.5)	75(34.6)	16(7.4)	31(14.3)	39(18.0)	9(4.1)
2015	219	49(22.4)	60(27.4)	1(0.5)	32(14.6)	17(7.8)	7(3.2)
2016	241	68(28.2)	61(25.3)	11(4.6)	35(14.5)	33(13.7)	6(2.5)
2017	217	59(27.2)	53(24.4)	15(6.9)	25(11.5)	23(10.6)	7(3.2)
2018	211	48(22.7)	44(20.9)	18(8.5)	25(11.8)	26(12.3)	9(4.3)
合计	1559	495(31.8)	523(33.5)	64(4.1)	153(9.8)	269(17.3)	104(6.7)
$χ 趋势 2$ 值		49.192	99.785	42.097	57.693	86.100	64.711
P值		0.000	0.000	0.000	0.000	0.000	0.000

耐药谱	初治(876株)		复治(747株)		合计(1623株)
耐药谱	耐药株数	构成比(%)	耐药株数	构成比(%)	耐药株数	构成比(%)
单药耐药	462	52.7	273	36.5	735	45.3
INH	136	15.5	80	10.7	216	13.3
RFP	72	8.2	105	14.1	177	10.9
EMB	1	0.1	1	0.1	2	0.1
Sm	139	15.9	30	4.0	169	10.4
Ofx	87	9.9	49	6.6	136	8.4
Km	27	3.1	8	1.1	35	2.2
耐多药	240	27.4	358	47.9	598	36.8
INH+RFP	74	8.4	142	19.0	216	13.3
INH+RFP+EMB	10	1.1	7	0.9	17	1.0
INH+RFP+EMB+Sm	9	1.0	12	1.6	21	1.3
INH+RFP+EMB+Sm+Ofx	2	0.2	6	0.8	8	0.5
INH+RFP+EMB+Sm+Ofx+Km	2	0.2	5	0.7	7	0.4
INH+RFP+EMB+Ofx	9	1.0	6	0.8	15	0.9
INH+RFP+EMB+Ofx+Km	4	0.5	3	0.4	7	0.4
INH+RFP+EMB+Sm+Km	3	0.3	3	0.4	6	0.4
INH+RFP+EMB+Km	2	0.2	3	0.4	5	0.3
INH+RFP+Sm	39	4.5	30	4.0	69	4.3
INH+RFP+Sm+Ofx	12	1.4	8	1.1	20	1.2
INH+RFP+Sm+Ofx+Km	3	0.3	8	1.1	11	0.7
INH+RFP+Sm+Km	1	0.1	2	0.3	3	0.2
INH+RFP+Ofx	31	3.5	72	9.6	103	6.3
INH+RFP+Ofx+Km	23	2.6	42	5.6	65	4.0
INH+RFP+Km	16	1.8	9	1.2	25	1.5
多耐药	174	19.9	116	15.5	290	17.9
仅含一线抗结核药品	70	8.0	39	5.2	109	6.7
INH+EMB	1	0.1	4	0.5	5	0.3
INH+Sm	45	5.1	20	2.7	65	4.0
RFP+EMB	5	0.6	2	0.3	7	0.4
RFP+EMB+Sm	5	0.6	4	0.5	9	0.6
RFP+Sm	14	1.6	9	1.2	23	1.4
耐药谱	初治(876株)		复治(747株)		合计(1623株)
耐药谱	耐药株数	构成比(%)	耐药株数	构成比(%)	耐药株数	构成比(%)
含二线抗结核药品	104	11.9	77	10.3	181	11.2
INH+Km	14	1.6	6	0.8	20	1.2
INH+EMB+Sm+Km	0	0.0	1	0.1	1	0.1
INH+EMB+Ofx	2	0.2	0	0.0	2	0.1
INH+EMB+Ofx+Km	1	0.1	0	0.0	1	0.1
INH+Sm+Ofx	2	0.2	4	0.5	6	0.4
INH+Sm+Km	3	0.3	1	0.1	4	0.2
INH+Sm+Ofx+Km	2	0.2	0	0.0	2	0.1
INH+Ofx	19	2.2	16	2.1	35	2.2
INH+Ofx+Km	7	0.8	2	0.3	9	0.6
RFP+EMB+Sm+Ofx	0	0.0	2	0.3	2	0.1
RFP+EMB+Ofx	0	0.0	2	0.3	2	0.1
RFP+Sm+Ofx	2	0.2	4	0.5	6	0.4
RFP+Sm+Km	1	0.1	0	0.0	1	0.1
RFP+Ofx	18	2.1	27	3.6	45	2.8
RFP+Ofx+Km	5	0.6	6	0.8	11	0.7
RFP+Km	11	1.3	2	0.3	13	0.8
EMB+Ofx	1	0.1	0	0.0	1	0.1
Sm+Ofx	4	0.5	2	0.3	6	0.4
Ofx+Km	12	1.4	2	0.3	14	0.8

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