Analysis of drug resistance characteristics and influencing factors of Mycobacterium tuberculosis in suburban areas of Hangzhou, 2022—2024

doi:10.19983/j.issn.2096-8493.20250165

Abstract

Abstract:

Objective: The aim of this study is to understand characteristics and influencing factors of Mycobacterium tuberculosis drug resistance in suburban counties of Hangzhou. Methods: A retrospective study was conducted to collect clinical data (including age, gender, registration time, registered residence, treatment classification, mycobacterium sputum culture, species identification, and drug susceptibility test results (isoniazid, rifampicin, ethambutol, levofloxacin, and moxifloxacin)) from 2456 clinically diagnosed pulmonary tuberculosis patients from designated hospitals in all eight suburban counties of Hangzhou from 2022 to 2024. Single-factor and multivariable logistic regression model were used to analyze the drug resistance characteristics and influencing factors among different populations. Results: In the 2456 isolates of mycobacteria, 2165 (88.15%) of the strains were identified as Mycobacterium tuberculosis complex, and 291 (11.85%) were non-tuberculous mycobacterium; 2254 (91.78%) were initial treatment cases, and 202 (8.22%) were retreatment cases; 1910 (88.22%) were sensitive to all five anti-tuberculosis drugs, while 255 (11.78%) were resistant strains; the total drug resistance, first-line anti-tuberculosis drug resistance, single drug resistance, multiple drug resistance and pre-extensive drug resistance rates were 11.78% (255/2165), 8.36% (181/2165), 6.28% (136/2165), 1.94% (42/2165) and 0.42% (9/2165), respectively. The resistance rate against isoniazid was the highest (7.62%, 165/2165), followed by levofloxacin and moxifloxacin (all 4.02%, 87/2165), rifampicin (2.59%, 56/2165), and ethambutol (1.15%, 25/2165); The drug resistance rates of isoniazid, rifampicin, ethambutol, total and multidrug resistance rates have all significantly decreased compared to the rates of 2017—2019 (10.53% (306/2907), 4.02% (117/2907), 2.03% (59/2907), 14.90% (433/2907), 3.06% (89/2907),χ²=12.431, P=0.005; χ²=7.790, P=0.005; χ²=5.831, P=0.016; χ²=10.281, P=0.001; χ²=6.204, P=0.013). There were a total of 14 patterns of 255 drug-resistant strains, among which 52.94% (135) of the drug-resistant strains were only resistant to one drug, with isoniazid resistance being the main type (45.88%, 117); 37.25% (95) of resistant strains were resistant to two drugs, with levofloxacin+moxifloxacin as the dominant pattern (27.84%, 71), followed by isoniazid+rifampicin pattern (8.24%, 21); Only 5.49% (14) of resistant strains were resistant to three drugs. The total drug resistance rate (highest in Lin’an District (18.62%) and lowest in Linping District (8.99%)), rifampicin resistance rate (highest in Yuhang District (5.47%) and lowest in Chun’an County (0.54%)) and multidrug resistance rate (highest in Yuhang District (5.47%) and lowest in Chun’an County (0.54%)) in 8 suburban counties showed statistically significant differences (χ²=14.556, P=0.042; χ²=17.551, P=0.014; χ²=16.177, P=0.024). The results of multiple logistic regression analysis showed that working in service industry (OR=7.887, 95%CI: 3.046-20.775), being cadres or staff (OR=5.143, 95%CI: 1.385-17.420), retreated patients (OR=3.313, 95%CI: 2.176-4.959), and aged over 60 years old (OR=1.801, 95%CI: 1.029-3.255) were risk factors for developing Mycobacterium tuberculosis drug resistance. Conclusion: The control of drug-resistant Mycobacterium tuberculosis in suburban areas of Hangzhou is generally satisfactory, but it is still necessary to strengthen management and standardized treatment among retreated patients with emphasis on drug resistance screening, and strengthen active tuberculosis screening among service industry workers, cadres and staff and the elderly population, to effectively control the spread of drug-resistant tuberculosis.

Key words: Mycobacterium tuberculosis, Tuberculosis,multidrug-resistant, Data interpretation,statistical, Factor analysis, statistical, Small-area analysis

CLC Number:

R378.91

Wu Yifei, Li Qingchun, Huang Yinyan, Jia Qingjun, Bai Xuexin, Cheng Qinglin. Analysis of drug resistance characteristics and influencing factors of Mycobacterium tuberculosis in suburban areas of Hangzhou, 2022—2024[J]. Journal of Tuberculosis and Lung Disease , 2026, 7(1): 49-58. doi: 10.19983/j.issn.2096-8493.20250165

Figures/Tables 7

组别	总耐药					利福平耐药
组别	β值	s $x ˉ$ 值	Wald χ²值	P值	OR(95%CI)值	β值	s $x ˉ$ 值	Wald χ²值	P值	OR(95%CI)值
性别
女性					1.000					1.000
男性	0.013	0.151	0.008	0.930	1.013(0.756~1.369)	0.857	0.380	5.100	0.024	2.356(1.173~5.280)
年龄组(岁)
≤30					1.000					1.000
31~60	0.367	0.260	1.991	0.158	1.444(0.880~2.451)	0.621	0.499	1.546	0.214	1.860(0.748~5.450)
>60	0.589	0.293	4.032	0.045	1.801(1.029~3.255)	0.962	0.598	2.587	0.108	2.618(0.855~9.118)
职业
离退人员					1.000					1.000
干部职员	1.638	0.636	6.632	0.010	5.143(1.385~17.420)	3.131	1.312	5.697	0.017	22.907(1.867~546.896)
工人	0.658	0.408	2.598	0.107	1.932(0.882~4.415)	2.150	1.112	3.737	0.053	8.583(0.971~75.907)
家务或待业	0.443	0.505	0.770	0.380	1.557(0.560~4.144)	0.960	1.452	0.437	0.508	2.613(0.098~69.469)
民工	0.815	0.594	1.881	0.170	2.260(0.650~6.965)	2.596	1.217	4.549	0.033	13.410(1.501~290.688)
服务行业	2.065	0.487	18.006	<0.001	7.887(3.046~20.775)	3.527	1.153	9.357	0.002	34.026(4.833~694.440)
农民	0.275	0.321	0.738	0.390	1.317(0.730~2.592)	0.934	1.031	0.820	0.365	2.544(0.521~45.948)
学生和教师	0.807	0.621	1.689	0.194	2.242(0.617~7.315)	3.245	1.294	6.291	0.012	25.665(2.465~611.227)
其他	0.596	0.709	0.706	0.401	1.815(0.377~6.629)	1.858	1.474	1.589	0.207	6.413(0.234~175.434)
户籍地
本地					1.000					1.000
外地	0.042	0.182	0.053	0.818	1.043(0.729~1.487)	0.590	0.352	2.806	0.094	1.805(0.908~3.623)
治疗分类
初治					1.000					1.000
复治	1.198	0.210	32.664	<0.001	3.313(2.176~4.959)	1.193	0.410	8.446	0.004	3.296(1.379~7.033)

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菌种	合计		初治		复治		χ²值	P值
菌种	例数	构成比(%)	例数	构成比(%)	例数	构成比(%)	χ²值	P值
结核分枝杆菌	2165	88.15	2031	90.11	134	66.34	100.285	<0.001
非结核分枝杆菌	291	11.85	223	9.89	68	33.66
合计	2456	100.00	2254	91.78	202	8.22

分类	总耐药(2165株)		初治耐药(2031株)		复治耐药(134株)		χ²值	P值
分类	株数	耐药率(%)	株数	耐药率(%)	株数	耐药率(%)	χ²值	P值
总耐药	255	11.78	218	10.73	37	27.61	34.463	<0.001
任一耐药
异烟肼	165	7.62	142	6.99	23	17.16	18.476	<0.001
利福平	56	2.59	48	2.36	8	5.97	6.490	0.011
乙胺丁醇	25	1.15	19	0.94	6	4.48	13.818	<0.001
左氧氟沙星	87	4.02	71	3.50	16	11.94	23.241	<0.001
莫西沙星	87	4.02	70	3.45	17	12.69	27.826	<0.001
一线药物耐药	181	8.36	155	7.63	26	19.40	22.735	<0.001
利福平耐药	56	2.59	48	2.36	8	5.97	6.490	0.011
单耐药	136	6.28	116	5.71	20	14.93	18.128	<0.001
多耐药	3	0.14	3	0.15	0	0.00	-	-
耐多药	42	1.94	36	1.77	6	4.48	4.835	0.028
准广泛耐药	9	0.42	6	0.30	3	2.24	11.468	0.001

耐药类型	2017—2019年(2907株)			2022—2024年(2165株)			χ²值	P值^a	χ²值	P值^b	χ²值	P值^c
耐药类型	初治	复治	合计	初治	复治	合计	χ²值	P值^a	χ²值	P值^b	χ²值	P值^c
异烟肼	241(9.53)	65(17.20)	306(10.53)	142(6.99)	23(17.16)	165(7.62)	9.429	0.002	-	0.993	12.431	0.005
利福平	86(3.40)	31(8.20)	117(4.02)	48(2.36)	8(5.97)	56(2.59)	4.248	0.039	0.700	0.403	7.790	0.005
乙胺丁醇	45(1.78)	14(3.70)	59(2.03)	19(0.94)	6(4.48)	25(1.15)	5.796	0.016	0.158	0.691	5.831	0.016
总耐药	341(13.48)	92(24.34)	433(14.90)	218(10.73)	37(27.61)	255(11.78)	7.919	0.005	0.562	0.453	10.281	0.001
耐多药	64(2.53)	25(6.61)	89(3.06)	36(1.77)	6(4.48)	42(1.94)	3.044	0.081	0.794	0.373	6.204	0.013

耐药谱	总耐药(255株)		初治(218株)		复治(37株)
耐药谱	株数	构成比(%)	株数	构成比(%)	株数	构成比(%)
耐1种药
INH	117	45.88	101	46.33	16	43.24
RFP	13	5.10	12	5.50	1	2.70
EMB	2	0.78	1	0.46	1	2.70
Lfx	1	0.39	1	0.46	0	0.00
Mfx	2	0.78	2	0.92	0	0.00
小计	135	52.94	117	53.67	18	48.65
耐2种药
INH+RFP	21	8.24	20	9.17	1	2.70
INH+EMB	3	1.18	3	1.38	0	0.00
Lfx+Mfx	71	27.84	60	27.52	11	29.73
小计	95	37.25	83	38.07	12	32.43
耐3种药
INH+RFP+EMB	10	3.92	8	3.67	2	5.41
INH+Lfx+Mfx	3	1.18	2	0.92	1	2.70
RFP+Lfx+Mfx	1	0.39	0	0.00	1	2.70
小计	14	5.49	10	4.59	4	10.81
耐4种药
IHN+RFP+EMB+Lfx	1	0.39	1	0.46	0	0.00
IHN+RFP+Lfx+Mfx	1	0.39	1	0.46	0	0.00
小计	2	0.78	2	0.92	0	0.00
耐5种药
IHN+RFP+EMB+Lfx+Mfx	9	3.53	6	2.75	3	8.11

地区	总株数	总耐药	异烟肼	利福平	乙胺丁醇	氟喹诺酮类	单耐药	一线药物	耐多药
淳安县	369	37(10.03)	26(7.05)	2(0.54)	3(0.81)	13(3.52)	25(6.77)	27(7.32)	2(0.54)
富阳区	338	36(10.65)	25(7.40)	9(2.66)	5(1.48)	12(3.55)	21(6.21)	27(7.99)	7(2.07)
建德市	288	40(13.89)	27(9.38)	12(4.17)	2(0.69)	14(4.86)	21(7.29)	30(10.42)	9(3.13)
临安区	145	27(18.62)	17(11.72)	2(1.38)	2(1.38)	9(6.21)	15(10.34)	18(12.41)	2(1.38)
临平区	356	32(8.99)	23(6.46)	12(3.37)	8(2.25)	7(1.97)	17(4.78)	27(7.58)	8(2.25)
桐庐县	215	21(9.77)	10(4.65)	2(0.93)	1(0.47)	11(5.12)	8(3.72)	10(4.65)	2(0.93)
萧山区	326	43(13.19)	25(7.67)	10(3.07)	2(0.61)	14(4.29)	24(7.36)	30(9.20)	5(1.53)
余杭区	128	19(14.84)	12(9.38)	7(5.47)	2(1.56)	9(7.03)	5(3.91)	12(9.38)	7(5.47)
合计	2165	255(11.78)	165(7.62)	56(2.59)	25(1.15)	89(4.11)	136(6.28)	181(8.36)	42(1.94)