关键词: 结核, 肺/流行病学, 抗药性, 细菌, Logistic模型, 厦门市

Abstract: Objective To understand the epidemic status of drug-resistant tuberculosis (TB) in Xiamen city in the recent years, to identify the risk factors for drug-resistance and to provide scientific evidences for developing effective local policies and measures on TB control. Methods A cross-sectional study was carried out. All smear-positive TB patients notified in the designated TB hospitals of Xiamen from July 1st, 2011 to Jun 30th, 2012 were enrolled in this study. The basic information, relevant medical information and sputum specimens were collected on every enrolled patient. Culture was performed on all subjects; drug susceptibility testing (DST) of 4 first-line anti-TB drugs (INH, RFP, Sm, EMB) was performed using proportion method; Mycobacterium tuberculosis (Mtb) identification was done using p-nitrobenzoic acid (PNB) cultivation. Unconditional logistic regression model was used with SPSS 18.0 to identify the potential risk factors for drug-resistance. Results The total number of the subjects was 776 cases. The overall drug-resistant TB (DR-TB) rate in Xiamen was 27.2%（198/729）and the overall multidrug-resistant TB (MDR-TB) rate was 9.7% (71/729). The drug-resistance rates for initial treatment TB patients and retreatment TB patients were 23.4% (134/573) and 41.0% (64/156) respectively. The multidrug-resistance rate for initial treatment TB patients was 7.3% (42/573) and it was 18.6% (29/156) for retreatment TB patients. Of 4 first-line anti-TB drugs tested in this study, the INH-resistance rate was 16.5% (120/729), ranking the first; the lowest drug-resistance rate was EMB (6.9%, 50/729). The drug-resistance rate among retreatment TB patients was significantly higher than that among initial treatment TB patients (χ²=19.286, P<0.01). Previous treatment was identified as the major risk factor of drug resistance (OR=2.154, 95%CI=1.467-3.163, Waldχ²=15.319, P<0.001). Conclusion The situation of drug-resistant TB in Xiamen is not optimistic and a history of previous TB treatment is associated with drug-resistance.

Key words: Tuberculosis, , pulmonary/epidemiology, Drug resistance, bacterial, Logistic models, Xiamen city