关键词: 结核,肺, 抗药性,细菌, 因素分析,统计学, 危险因素

Abstract:

Objective: To analyze the status and characteristics of drug resistance and influencing factors among high-risk group of drug resistant tuberculosis in Guangzhou. Methods: Information of 2155 high-risk group of drug-resistant tuberculosis in Guangzhou from January 1, 2014 to December 31, 2019 was collected from “Tuberculosis Management Information System of China Information System for Disease Control and Prevention”, including sociodemographic characteristics, drug resistance screening results and so on, relevant information of 2155 subjects was finally included. Drug resistance status, sequence, spectrum and influencing factors of five anti-tuberculosis drugs including isoniazid (INH), rifampicin (RFP), ethambutol (EMB), ofloxacin (Ofx) and kanamycin (Km) were analyzed. Results: Among 2155 subjects, 768 were drug resistant cases, with the total drug resistance rate of 35.64%. The rates of single drug resistance, multi-drug resistance, and extensively drug resistance were 10.39% (224/2155), 24.36% (525/2155), and 0.88% (19/2155), respectively. The drug resistance rates of INH, RFP, EMB, Ofx, Km were 31.97% (689/2155), 29.05% (626/2155), 10.72% (231/2155), 7.75% (167/2155), 2.55% (55/2155), respectively. The percentages of drug resistance including 1 to 5 anti-tuberculosis drugs were 24.22% (186/768), 39.97% (307/768), 24.87% (191/768), 9.38% (72/768) and 1.56% (12/768), respectively. Among the single drug resistance subjects, INH was the most common, accounting for 15.23% (117/768); among those who resistant to 2 anti-tuberculosis drugs, INH+RFP was the most common, accounting for 35.94% (276/768); among those who resistant to 3 anti-tuberculosis drugs, INH+RFP+EMB resistance was the most common, accounting for 16.80% (129/768); among those who resistant to 4 anti-tuberculosis drugs, INH+RFP+EMB+Ofx was the most common, accounting for 6.51% (50/768). Multivariate logistic regression analysis showed that the risk of drug resistance in patients ≥65 years old was 37.9% of the patients <25 years old (OR=0.379, 95%CI: 0.226-0.634); as to the occupational classification, the risk of drug resistance in business service, teachers, medical staff and cadres, farmers, and others was 2.419 times (95%CI: 1.429-4.096), 2.541 times (95%CI: 1.325-4.873), 1.479 times (95%CI: 1.028-2.127), and 6.452 times (95%CI: 4.624-9.003) that of retirees, respectively; as to the classification of patients, the risk of drug resistance of initial treatment failure, retreatment failure/chronic patients, relapse and others was 9.443 times (95%CI: 6.009-14.621), 7.504 times (95%CI: 4.634-12.151), 2.567 times (95%CI: 1.968-3.348) and 3.091 times (95%CI: 1.969-4.854) that of sputum smear positive patients at the end of 2 and 3 months after initial treatment, respectively. Conclusion: In recent years, more than 1/3 of the high-risk group of drug resistant tuberculosis in Guangzhou has developed drug resistance, and the situation of drug resistance cannot be ignored. Among the high-risk group of drug resistant tuberculosis, we should focus on young and middle-aged people, business services, teachers, doctors, employees of enterprises and institutions, farmers and other practitioners, as well as people who have failed initial treatment, failed retreatment/chronic patients, and relapsed.

Key words: Tuberculosis, pulmonary, Drug resistance, bacterial, Factor analysis, statistical, Risk factors