Analysis of drug resistance characteristics of pulmonary tuberculosis in children in Guangdong, 2014—2020

doi:10.19982/j.issn.1000-6621.20230109

Abstract

Abstract:

Objective: To investigate the drug resistance characteristics of Mycobacterium tuberculosis (MTB) isolates from children with pulmonary tuberculosis (PTB) in Guangdong Province from 2014 to 2020. Methods: According to the enrollment standard, 1274 (3.3%) MTB isolates from children aged 0 to 18 were collected from 32 sentinel sites of PTB resistance surveillance (39046 MTB isolates) in Guangdong Province from January 1, 2014 to December 30, 2020. Analysed the data of drug resistance of MTB isolates for first- and second-line of anti-TB drugs (including isoniazid (INH), streptomycin (Sm), ethambutol (EMB), rifampicin (RFP), kanamycin (Km), propylthioisoniacin (Pto), capreomycin (Cm), ofloxacin (Ofx), and sodium p-aminosalicylate (PAS)) and summarized the drug resistance characteristics. Results: The proportion of PTB children was dropped from 4.3% (123/2856) in 2014 to 3.1% (177/5760) in 2020, showing a downward trend of year by year ($X_{trend}^{2}$=25.864, P<0.001). The resistance rates of the isolates to anti-TB drugs from high to low were Sm (14.8% (189/1274))>INH (7.7% (98/1274))>RFP (6.3% (80/1274))>EMB (6.0% (77/1274))>Ofx (3.5% (44/1274))=PAS (3.5% (44/1274))>Pto (2.9% (37/1274))>Km (2.5% (32/1274))>Cm (2.2% (28/1274)), and the drug resistance rate, mono-resistance rate, poly-resistance rate, multidrug-resistance rate (MDR) and extensively drug resistance rate (XDR) of MTB of the 1274 isolates was 26.0% (331/1274), 15.4% (196/1274), 4.2% (54/1274), 3.1% (39/1274), and 0.8% (10/1274), respectively. The XDR of MTB in children aged 0 to 12 was significantly higher than that in children aged 13 to 18 (3.0% (3/100) vs. 0.6% (7/1174); χ²=6.837, P=0.038). In addition, the XDR of MTB in boys was significantly higher than that in girls (1.3% (10/749) vs. 0.0% (0/525); χ²=10.679, P=0.007), and the resistance rate of MTB in the Pearl River Delta was significantly higher than that in eastern and northwestern Guangdong (28.1% (213/758) vs. 22.9% (118/516); χ²=4.370, P=0.037). Conclusion: The prevalence of PTB in children in Guangdong Province is serious. The drug resistance in PTB children aged 0-12 years, who were boys, and who lived in Pearl River Delta should be paid special attention.

Key words: Child, Mycobacterium tuberculosis, Tuberculosis, multidrug-resistant, Population surveillance

CLC Number:

R181.2
R52

Zhuo Wenji, Zhang Chenchen, Chen Xunxun, Wei Wenjing, Yu Meiling, Peng Kehao, Xu Liuyue, Chen Yanmei. Analysis of drug resistance characteristics of pulmonary tuberculosis in children in Guangdong, 2014—2020[J]. Chinese Journal of Antituberculosis, 2023, 45(7): 687-692. doi: 10.19982/j.issn.1000-6621.20230109

Figures/Tables 5

年份	全年龄段人群分离菌株数	儿童患者分离菌株
年份	全年龄段人群分离菌株数	合计	耐药	单耐药	多耐药	耐多药	广泛耐药
2014	2856	123(4.3)	28(22.8)	15(12.2)	5(4.1)	4(3.3)	0(0.0)
2015	4943	146(3.0)	32(21.9)	19(13.0)	4(2.7)	4(2.7)	1(0.7)
2016	6087	156(2.6)	37(23.7)	22(14.1)	5(3.2)	5(3.2)	1(0.6)
2017	7045	228(3.2)	63(27.6)	39(17.1)	9(3.9)	10(4.4)	4(1.8)
2018	5930	210(3.5)	57(27.1)	36(17.1)	8(3.8)	3(1.4)	0(0.0)
2019	6425	234(3.6)	59(25.2)	28(12.0)	16(6.8)	7(3.0)	1(0.4)
2020	5760	177(3.1)	55(31.1)	37(20.9)	7(4.0)	6(3.4)	3(1.7)
合计	39046	1274(3.3)	331(26.0)	196(15.4)	54(4.2)	39(3.1)	10(0.8)
$χ 趋势 2$ 值		25.864	5.260	9.049	5.300	3.380	9.220
P值		<0.001	0.511	0.171	0.506	0.760	0.162

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特征	分离株	单耐药	χ²值	P值	多耐药	χ²值	P值	耐多药	χ²值	P值	广泛耐药	χ²值	P值
性别			3.591	0.058		0.602	0.438		0.094	0.759		10.679	0.007
男性	749(58.8)	180(24.0)			29(3.9)			22(2.9)			10(1.3)
女性	525(41.2)	151(28.8)			25(4.8)			17(3.2)			0(0.0)
年龄组(岁)			0.911	0.340		0.829	0.362		1.375	0.241		6.837	0.038
0~12	100(7.8)	30(30.0)			6(6.0)			5(5.0)			3(3.0)
13~18	1174(92.2)	301(25.6)			48(4.1)			34(2.9)			7(0.6)
地区			4.370	0.037		0.662	0.416		1.582	0.209		1.758	0.216
粤东西北	516(40.5)	118(22.9)			19(3.7)			12(2.3)			2(0.4)
珠江三角洲	758(59.5)	213(28.1)			35(4.6)			27(3.6)			8(1.1)
居住地			0.231	0.631		0.105	0.746		0.920	0.338		1.038	0.308
城市	688(54.0)	175(25.4)			28(4.1)			24(3.5)			7(1.0)
农村	586(46.0)	156(26.6)			26(4.4)			15(2.6)			3(0.5)
民族			1.024	0.311		0.768	0.381		0.997	0.318		0.218	0.641
汉族	1184(92.9)	305(25.8)			49(4.1)			35(3.0)			9(0.8)
少数民族	90(7.1)	25(27.8)			5(5.6)			4(4.4)			1(1.1)

年份	分离株数	耐INH	耐Sm	耐EMB	耐RFP	耐Km	耐Pto	耐Cm	耐Ofx	耐PAS
2014	123	11(8.9)	19(15.4)	9(7.3)	5(4.1)	4(3.3)	1(0.8)	1(0.8)	5(4.1)	2(1.6)
2015	146	10(6.8)	19(13.0)	7(4.8)	6(4.6)	3(2.1)	3(2.1)	1(0.7)	5(3.4)	2(1.4)
2016	156	9(5.8)	25(16.0)	6(3.8)	7(4.5)	3(1.9)	5(3.2)	3(1.9)	7(4.5)	4(2.6)
2017	228	23(10.1)	41(18.0)	10(4.4)	17(7.5)	2(0.9)	9(3.9)	5(2.2)	10(4.4)	9(3.9)
2018	210	9(4.3)	21(10.0)	13(6.2)	17(8.1)	9(4.3)	5(2.4)	7(3.3)	5(2.4)	12(5.7)
2019	234	23(9.8)	39(16.7)	15(6.4)	11(4.7)	5(2.1)	6(2.6)	5(2.1)	7(3.0)	8(3.4)
2020	177	13(7.3)	25(14.1)	17(9.6)	17(9.6)	6(3.4)	8(4.5)	6(3.4)	5(2.8)	7(4.0)
合计	1274	98(7.7)	189(14.8)	77(6.0)	80(6.3)	32(2.5)	37(2.9)	28(2.2)	44(3.5)	44(3.5)
χ²值		8.039	6.960	7.198	9.073	6.499	5.149	5.141	2.317	7.023
P值		0.235	0.325	0.303	0.169	0.370	0.525	0.526	0.888	0.319

分类	菌株	耐INH	耐Sm	耐EMB	耐RFP	耐Km	耐Pto	耐Cm	耐Ofx	耐PAS
初治	1255(98.5)	97(7.7)	184(14.7)	76(6.1)	78(6.2)	31(2.5)	37(2.9)	27(2.2)	43(3.4)	43(3.4)
复治	19(1.5)	1(5.3)	5(26.3)	1(5.3)	2(10.5)	1(5.3)	0(0.0)	1(5.3)	1(5.3)	1(5.3)
合计	1274(100.0)	98(7.7)	189(14.8)	77(6.0)	80(6.3)	32(2.5)	37(2.9)	28(2.2)	44(3.5)	44(3.5)
χ²值		0.160	2.012	0.021	0.591	0.596	0.005	0.843	0.189	0.189
P值		0.689	0.156	0.886	0.337	0.385	1.000	0.346	0.490	0.490

分类	菌株	耐药	单耐药	多耐药	耐多药	广泛耐药
初治	1255(98.5)	325(25.9)	192(15.3)	53(4.2)	38(3.0)	10(0.8)
复治	19(1.5)	6(31.6)	4(21.1)	1(5.3)	1(5.3)	0(0.0)
合计	1274(100.0)	331(26.0)	196(15.4)	54(4.2)	39(3.1)	10(0.8)
χ²值		0.314	0.476	0.050	0.315	0.153
P值		0.575	0.517	0.563	0.448	1.000