Abstract:

Objective To analyze the status and risk factors of drug-resistant tuberculosis in Shanghai, and provide the basis for further developing the prevention and control measures. Methods A total of 34 165 patients with pulmonary tuberculosis were newly registered in Shanghai from 2013 to 2017, of which 9746 sputum culture-positive mycobacteria strains were sent to the Shanghai Center for Disease Control and Prevention by local designated tuberculosis hospitals, and received bacterial identification and solid proportional drug susceptibility testing. The following strains were excluded, including 1377 strains (14.13%) of non-tuberculous mycobacteria, 307 strains (3.15%) without drug susceptibility testing results, 63 strains (0.65%) of patients under 15 years old, 556 strains (5.70%) strains with missing or duplicated accession numbers. Finally, 7443 (76.37%) Mycobacterium tuberculosis (MTB) strains were included for analysis. SAS 9.4 software was used to analyze the characteristics of drug-resistant tuberculosis in Shanghai. The count data were analyzed by χ² test, while when the theoretical frequency was <5, Fisher’s exact probability method was used to calculate the bilateral P value; trend analysis was performed by Cochran-Mantel-Haenszel test; the influencing factors of drug-resistant tuberculosis and multidrug-resistant tuberculosis were analyzed by unconditional logistic regression model, and the test level was α=0.05. Results The total drug resistance rate, multidrug resistance rate and multiple drug resistance rate of tuberculosis in Shanghai from 2013 to 2017 were 21.03% (1565/7443), 4.98% (371/7443) and 4.16% (310/7443), respectively, of which the first two showed a downward trend ({\chi }_{\mathrm{trend}}^2=15.685, P=0.004; and {\chi }_{\mathrm{trend}}^2=6.554, P=0.011). The total drug resistance rates of tuberculosis patients resistant to any rifampicin, isoniazid, streptomycin and ethambutol in Shanghai from 2013 to 2017 were 6.01% (447/7443), 11.41% (849/7443), 15.75% (1172/7443), and 4.61% (343/7443), respectively. The total drug resistance rates of all four drugs showed downward trend, with the statistically significant difference ({\chi }_{\mathrm{trend}}^2=7.777, P=0.005; {\chi }_{\mathrm{trend}}^2=7.221, P=0.007; {\chi }_{\mathrm{trend}}^2=9.260, P=0.002; {\chi }_{\mathrm{trend}}^2=20.562, P=0.000). The total drug resistance rates of tuberculosis patients resistant to single drug, two drugs, three drugs, and four drugs were 11.88% (884/7443), 4.25% (316/7443), 2.22% (165/7443), and 2.69% (200/7443), respectively. Multivariate logistic regression analysis showed that the prevalence of drug-resistant and multidrug-resistant tuberculosis was lower in patients aged ≥65 year (β=-0.543, Wald χ²=23.036, P<0.001, OR=0.581, 95%CI: 0.466-0.725; β=-0.797, Wald χ²=11.538, P=0.001, OR=0.451, 95%CI: 0.285-0.714), and re-treatment was a risk factor for drug-resistant and multidrug-resistant tuberculosis (β=0.904, Wald χ²=93.722, P<0.001, OR=2.469, 95%CI: 2.056-2.964; β=1.636, Wald χ²=153.545, P<0.001, OR=5.135, 95%CI: 3.964-6.652). Conclusion The drug resistance status of tuberculosis is at a low level in Shanghai, showing a downward trend year by year. The prevalence of drug-resistant and multidrug-resistant tuberculosis is lower in patients aged ≥65 years, and higher in patients with re-treatment.

Key words: Mycobacterium tuberculosis, Tuberculosis,multidrug-resistant, Microbial sensitivity tests, Epidemiologic studies, Factor analysis,statistical, Data interpretation,statistical