Abstract:

Objective To analyze the characteristics and influencing factors of tuberculosis patients’ resistance to first-line anti-tuberculosis drugs in Hangzhou from 2014 to 2018, and to provide scientific basis for the prevention and treatment of drug-resistant tuberculosis in Hangzhou. Methods A total of 12851 active tuberculosis patients were collected from the permanent residents of Hangzhou who visited the Tuberculosis Diagnosis and Treatment Center of Integrated Chinese and Western Medicine Hospital of Zhejiang Province from 2014 to 2018. All of 3807 patients with positive Mycobacterium tuberculosis culture and comprehensive information of drug sensitivity test (“ drug susceptibility test ”) for first-line anti-tuberculosis drugs were enrolled. Through the National Tuberculosis Information Management System and the Tuberculosis Laboratory Information System to collect the sex, age, household registration, occupation, classification of treatment (initial and retreated), pulmonary cavity, case sources and current residence of the patients, Mycobacterium tuberculosis culture and drug susceptibility test results. Drug resistance characteristics and influencing factors of drug-resistant pulmonary tuberculosis patients in Hangzhou were studied by univariate and multi-factor logistic regression analysis. Results Of the 3807 strains, 907 strains (23.82%) were resistant to four first-line anti-tuberculosis drugs. The drug resistance sequence was isoniazid (18.57%, 707 cases), streptomycin (18.41%, 701cases), rifampicin (12.03%,458 cases) and ethambutol (6.41%,244 cases). The multidrug-resistance and polyresistance rates were 11.11% (423/3807) and 4.44% (169/3807). Of the tuberculosis patients in different years from 2014 to 2018, the drug resistance rates were 22.87% (185/809), 25.55% (198/775), 25.60% (181/707), 23.04% (188/816) and 22.14% (155/700), respectively, with no significant difference ($χ^{2}_{trend}$=4.275, P=0.370). The multidrug-resistance rates (11.12% (90/809), 13.16% (102/775), 11.88% (84/707), 11.40% (93/816) and 7.71% (54/700)) had statistically significant difference ( $χ^{2}_{trend}$=11.276, P=0.024). Multivariate logistic regression analysis showed that, compared to men and initial patients, women and retreated pulmonary tuberculosis patients were risk factors for drug resistance (OR (95%CI)=1.308(1.111-1.540), OR (95%CI)=4.281(3.498-5.238)). Compared to Xiasha District, patients living in the other six districts were more likely to develop drug resistance, Xiaoshan District and Fuyang District were at higher risk (OR (95%CI)=4.400(2.559-7.565), OR (95%CI)=3.803(2.037-7.098)).Compared with male, less than 40 years old and newly treated patients, female, over 40 years old and retreated patients were risk factors for multi-drug resistance (OR (95%CI)=1.724 (1.364-2.178); 40-year-old group: OR (95%CI)=3.418 (1.599-7.305), 60-year-old group: OR (95%CI)=3.885 (1.832-8.239); retreatment: OR (95%CI)=7.645 (5.984-9.766)). Conclusion The key to reducing the development and transmission of drug-resistant and multidrug-resistant tuberculosis in Hangzhou is to strengthen the management and treatment of patients aged over 40 years old, retreated, female, living in Xiaoshan and Fuyang District.

Key words: Tuberculosis,pulmonary, Tuberculosis,multi-drug resistant, Data interpretation,statistical, Factor analysis,statistical, Small-area analysis