Abstract:

Objective: To analyze the drug resistance status and change trend among pulmonary tuberculosis (PTB) patients in Jilin City in recent years. Methods: A retrospective study was conducted, basic information and drug susceptibility test (DST) result of Mycobacterium tuberculosis from samples of 796 sputum-positive PTB patients admitted to Jilin City Tuberculosis Hospital between January 2023 and June 2024 were collected according to inclusion criteria. Their drug resistance status was analyzed, and time-series trend prediction was performed for different types of drug resistance. Results: From January 2023 to June 2024, the overall drug resistance rate to 16 anti-tuberculosis drugs among 796 patients was 43.59% (347/796). The rates of multidrug resistance (MDR), mono-drug resistance, poly-drug resistance, and pre-extensive drug resistance (pre-XDR) were 14.82% (118/796), 9.30% (74/796), 2.01% (16/796), and 5.90% (47/796), respectively. No extensively drug-resistant (XDR) cases were detected. The drugs with a resistance rate exceeding 10% were ranked as follows: streptomycin (26.26%, 209/796)>isoniazid (23.87%, 190/796)>rifampicin (18.84%, 150/796)>rifabutin (14.70%, 117/796)>levofloxacin (13.57%, 108/796)>moxifloxacin (12.31%, 98/796)>pasiniazide (11.43%, 91/796). The mono-drug resistance rate in the elderly group (13.20%, 45/341) was higher than that in the middle-aged group (5.86%, 17/290) and the young group (7.27%, 12/165). The MDR rates in the young group (20.00%, 33/165) and middle-aged group (18.97%, 55/290) were higher than that in the elderly group (8.80%, 30/341). Pre-XDR rates in the young group (7.88%, 13/165) and middle-aged group (10.00%, 29/290) were also higher than that in the elderly group (2.05%, 7/341). All differences were statistically significant (χ²=11.009, P=0.004; χ²=17.248, P<0.001; χ²=18.204, P<0.001). MDR (28.02%, 72/257) and pre-XDR rates (14.79%, 38/257) were higher in retreatment patients than in new patients (8.53% (46/539) and 2.03% (11/539), respectively), with statistically significant differences (χ²=52.307, P<0.001; χ²=48.934, P<0.001). Time-series analysis predicted that drug resistance rates from July to December 2024 should be 6.67% for mono-drug resistance, 0.78% for poly-drug resistance, an increase in MDR to 11.92%, and a pre-XDR rate of 4.02%. Conclusion: Between January 2023 and June 2024, different kinds of drug resistance among PTB patients in Jilin City remained high. Predictions for July to December 2024 indicate MDR and pre-XDR levels remained high, however, all four types of resistance have a downward trend. Strengthened management and real-time monitoring of drug use and resistance to streptomycin, isoniazid, rifampicin, rifabutin, levofloxacin, and other drugs are necessary, especially for mono-drug resistance in elderly patients and MDR in young and middle-aged patients, to reduce the occurrence of MDR and pre-XDR cases.

Key words: Tuberculosis, multidrug-resistant, Drug monitoring, Models, statistical, Forecasting, Communicable disease control