Investigation of drug resistance status and risk factors of multidrug-resistance in 249 aged pulmonary tuberculosis patients

doi:10.3969/j.issn.1000-6621.2021.06.020

Abstract

Abstract:

Results of drug sensitivity test and clinical data of 249 aged pulmonary tuberculosis patients with positive sputum culture hospitalized in Shenyang Tenth People’s Hospital from January 1, 2020 to December 31, 2020 were collected. Strains from all the patients were identified as Mycobacterium tuberculosis. A single factor and multiple factors unconditioned logistic regression analysis were used to analyze the risk factors of drug resistance. The total drug resistance rate (TDRR), initial treatment DRR and retreatment DRR were 32.53% (81/249), 24.24% (40/165) and 48.81% (41/84), respectively. The retreatment DRR was significantly higher than initial treatment DRR (χ²=15.307, P=0.000). The total multi-drug resistance rate, initial treatment and retreatment multi-drug resistance rate were 12.85% (32/249), 7.27% (12/165) and 23.81% (20/84), respectively. The multi-drug resistance rate of retreatment was significantly higher than that of initial treatment (χ²=13.591, P=0.000). No extensive drug resistance was found. According to multiple factors logistic regression analysis, retreatment (OR=4.201, 95%CI=1.467-12.033) and tuberculous cavity (OR=2.406, 95%CI=1.019-5.681) were independent risk factors of multidrug-resistance in elderly pulmonary tuberculosis patients. The drug resistance rate of elderly pulmonary tuberculosis was high, the drug resistance screening should be actively carried out.

Key words: Tuberculosis,pulmonary, Aged, Tuberculosis,multidrug-resistant, Factor analysis,statistical

XI Ying, TANG Jun, QIAO Rui-jun, SUN Feng, YU Yan-hong. Investigation of drug resistance status and risk factors of multidrug-resistance in 249 aged pulmonary tuberculosis patients[J]. Chinese Journal of Antituberculosis, 2021, 43(6): 636-641. doi: 10.3969/j.issn.1000-6621.2021.06.020

Figures/Tables 4

References 15

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药敏试验结果	初治患者(165例)		复治患者(84例)		合计(249例)
总耐药	40(24.24)		41(48.81)		81(32.53)
任一耐药
INH	25(15.15)		33(39.29)		58(23.29)
RFP	13(7.88)		24(28.57)		37(14.86)
Rfb	5(3.03)		5(5.95)		10(4.02)
Sm	32(19.39)		17(20.24)		49(19.68)
EMB	0(0.00)		3(3.57)		3(1.20)
Pto	1(0.61)		0(0.00)		1(0.40)
PAS	5(3.03)		5(5.95)		10(4.02)
Am	6(3.64)		2(2.38)		8(3.21)
Km	3(1.82)		2(2.38)		5(2.01)
Cm	1(0.61)		1(1.19)		2(0.80)
药敏试验结果		初治患者(165例)		复治患者(84例)	合计(249例)
Lfx		1(0.61)		0(0.00)	1(0.40)
Mfx		0(0.00)		0(0.00)	0(0.00)
Cfz		0(0.00)		0(0.00)	0(0.00)
Cs		0(0.00)		0(0.00)	0(0.00)
Lzd		1(0.61)		2(2.38)	3(1.20)
单耐药		17(10.30)		14(16.67)	31(12.45)
INH		2(1.21)		7(8.33)	9(3.61)
RFP		0(0.00)		2(2.38)	2(0.80)
RFP+Rfb^a		1(0.61)		1(1.19)	2(0.80)
Sm		14(8.48)		3(3.57)	17(6.83)
PAS		0(0.00)		1(1.19)	1(0.40)
多耐药		11(6.67)		7(8.33)	18(7.23)
INH+Sm		6(3.64)		2(2.38)	8(3.21)
RFP+Sm		0(0.00)		1(1.19)	1(0.40)
INH+EMB		0(0.00)		1(1.19)	1(0.40)
INH+Am		0(0.00)		1(1.19)	1(0.40)
INH+Am+Km		1(0.61)		0(0.00)	1(0.40)
INH+PAS+Sm		1(0.61)		0(0.00)	1(0.40)
INH+Km+PAS		1(0.61)		0(0.00)	1(0.40)
INH+Am+PAS+Sm		1(0.61)		0(0.00)	1(0.40)
INH+Km+PAS+Lzd		0(0.00)		1(1.19)	1(0.40)
INH+EMB+Cm+PAS+Lzd		0(0.00)		1(1.19)	1(0.40)
INH+Sm+Pto+Lfx+Am+Cm+Lzd		1(0.61)		0(0.00)	1(0.40)
耐多药		12(7.27)		20(23.81)	32(12.85)
INH+RFP		1(0.61)		7(8.33)	8(3.21)
INH+RFP+Rfb		2(1.21)		2(2.38)	4(1.61)
INH+RFP+Sm		4(2.42)		6(7.14)	10(4.02)
INH+RFP+Rfb+Sm		1(0.61)		2(2.38)	3(1.20)
INH+RFP+Sm+Am		1(0.61)		0(0.00)	1(0.40)
INH+RFP+Sm+Km		0(0.00)		1(1.19)	1(0.40)
INH+RFP+Sm+PAS		0(0.00)		1(1.19)	1(0.40)
INH+RFP+Sm+Am+Km		1(0.61)		0(0.00)	1(0.40)
INH+RFP+Sm+Am+PAS		1(0.61)		0(0.00)	1(0.40)
INH+RFP+Rfb+Sm+PAS		1(0.61)		0(0.00)	1(0.40)
INH+RFP+EMB+Sm+Am+PAS		0(0.00)		1(1.19)	1(0.40)

影响因素	耐多药(32例)		全敏感(168例)		χ²值	P值
影响因素	例数	构成比(%)	例数	构成比(%)	χ²值	P值
性别					0.056	0.813
男性	25	78.12	128	76.19
女性	7	21.88	40	23.81
年龄组(岁)					1.153	0.283
65~74	23	71.88	104	61.90
75~95	9	28.12	64	38.10
居住地					0.390	0.532
城市	20	62.50	95	56.55
农村	12	37.50	73	43.45
吸烟					0.867	0.352
是	15	46.88	64	38.10
否	17	53.12	104	61.90
糖尿病					0.119	0.730
是	8	25.00	47	27.98
否	24	75.00	121	72.02
慢性肺部疾病					0.392	0.531
是	3	9.38	8	4.76
否	29	90.62	160	95.24
体质量指数					1.758	0.185
<18.5	16	50.00	63	37.50
≥18.5	16	50.00	105	62.50
低白蛋白血症(白蛋白<40g/L)					2.174	0.140
是	24	75.00	103	61.31
否	8	25.00	65	38.69
既往规律抗结核治疗					11.578	0.001
是	17	53.12	136	80.95
否	15	46.88	32	19.05
患者类型					16.967	0.000
初治	12	37.50	125	74.40
复治	20	62.50	43	25.60
肺结核空洞					6.332	0.012
有	23	71.88	80	47.62
无	9	28.12	88	52.38
肺部病变范围					0.002	0.968
<3个肺野	6	18.75	31	18.45
≥3个肺野	26	81.25	137	81.55
痰涂片结果					1.153	0.283
阳性	23	71.88	104	61.90
阴性	9	28.12	64	38.10

变量	赋值
既往是否进行规律抗结核治疗	是=1;否=2
患者类型	初治=1;复治=2
是否有肺结核空洞	无=1;有=2

影响因素	β值	$s\bar{x}$值	Wald χ²值	P值	OR值	95%CI值
既往规律抗结核治疗	0.084	0.551	0.023	0.878	1.088	0.370~3.201
复治	1.435	0.537	7.147	0.008	4.201	1.467~12.033
有肺结核空洞	0.878	0.438	4.014	0.045	2.406	1.019~5.681