Jin Huang, Xianjin Cao, Mingdong Wang, Lvtong Du, Xiaojie Chen, Yujuan Tu, Yonghong Feng
From 2018 to 2023, the prevalence of RR-TB, MDR-TB, and fluoroquinolone-resistant TB increased markedly in Guizhou Province. To reduce the incidence and spread of MDR/RR-TB, future efforts should strengthen prevention and control measures for DR-TB in vulnerable populations including young and middle-aged adults, the unemployed, and individuals with previous treatment failures as well as in high-risk locations.
PURPOSE: Drug-resistant tuberculosis (DR-TB), particularly multidrug-resistant (MDR-TB) and rifampicin-resistant TB (RR-TB), poses a major public health challenge. In Guizhou Province, a high-burden region for tuberculosis (TB) in China, data on long-term drug resistance profile characteristics and trends remain limited. This study aimed to characterize the epidemiological patterns, drug resistance profiles, and temporal trends of DR-TB in Guizhou Province from 2018 to 2023.
PATIENTS AND METHODS: This retrospective study included 9,389 hospitalized pulmonary TB patients from the Guiyang Public Health Clinical Center. Sociodemographic and phenotypic drug susceptibility testing data were extracted from laboratory databases. Trend chi-square tests and multivariate logistic regression were used to analyze resistance trends and identify risk factors for MDR/RR-TB.
RESULTS: Among 9,389 patients, 2,669 (28.43%) had DR-TB. Resistance rates to the four first-line anti-TB drugs were: isoniazid 16.92%, rifampicin 12.46%, streptomycin 11.81%, and ethambutol 5.27%. For second-line drugs, rates were: moxifloxacin 5.02%, para-aminosalicylic acid 4.96%, levofloxacin 4.58%, kanamycin 2.89%, capreomycin 2.62%, clofazimine 1.84%, amikacin 1.51%, and protionamide 1.04%. The prevalence of RR-TB, MDR-TB, and pre-extensively drug-resistant TB (Pre-XDR-TB) was 12.46%, 10.05%, and 2.62%, respectively. Significant increasing trends were observed for resistance to rifampicin, fluoroquinolones (levofloxacin/moxifloxacin), and clofazimine. The most common resistance patterns were MDR2 (INH+RIF, 7.68%) and PDR2 (INH+SM, 5.36%). MDR/RR-TB cases clustered geographically in Guiyang and Bijie. Significant risk factors included age 19-39 years (AOR=1.520, 95% CI: 1.026-2.252), unemployment (AOR=1.330, 95% CI: 1.103-1.604), and prior TB treatment (AOR=6.422, 95% CI: 5.533-7.454).
CONCLUSION: From 2018 to 2023, the prevalence of RR-TB, MDR-TB, and fluoroquinolone-resistant TB increased markedly in Guizhou Province. To reduce the incidence and spread of MDR/RR-TB, future efforts should strengthen prevention and control measures for DR-TB in vulnerable populations including young and middle-aged adults, the unemployed, and individuals with previous treatment failures as well as in high-risk locations.