Abstract:

Objective: The aim of this study is to analyze prevalence of drug resistant tuberculosis in China in 2018, and provide evidence for formulating policies about treatment and prevention of tuberculosis. Methods: The 70 clusters selected by the National Drug Resistant Tuberculosis Baseline Survey during 2007—2008 were used as survey sites, newly diagnosed smear positive pulmonary tuberculosis patients were recruited in this study in 2018. Standardized questionnaire was used to collect socio-demographic features, disease histories and medical treatment histories of these patients. Sputum samples were collected from presumptive pulmonary tuberculosis patients visiting the surveysites for smear and culture. Positive isolates were transferred to provincial or municipal Centers for Disease Control and Prevention or tuberculosis institutes for bacteria identification and drug susceptibility test. Survey procedures of SAS 9.4 software were used to calculate the weighted drug resistant prevalence considering the complex sampling design and sampling weight. Logistic regression model was used to assess changes in prevalence. Results: 3820 new smear positive pulmonary tuberculosis patients and 643 retreated smear positive patients were included in the survey. Prevalence of rifampicin resistant tuberculosis (RR-TB) was 5.08% (95%CI: 4.39%-5.77%) and 23.31% (95%CI: 20.14%-26.48%) in new cases and retreated patients, respectively. Multidrug resistant tuberculosis (MDR-TB) accounted for 3.52% (95%CI: 2.94%-4.11%) of new cases, and 18.01% (95%CI: 15.36%-20.67%) of retreated patients. Compared with the 2007—2008 baseline survey, the RR-TB prevalence in new cases (OR(95%CI): 0.71 (0.58-0.87);P<0.001) and retreated patients (OR(95%CI): 0.53 (0.41-0.68);P<0.001) decreased significantly. The MDR-TB prevalence of new cases (OR(95%CI): 0.53 (0.42-0.67);P<0.001) and retreated patients (OR(95%CI): 0.47 (0.36-0.61);P<0.001) also decreased significantly. It was estimated that the numbers of RR-TB patients were 12662 (95%CI: 10942-14382) and 8156 (95%CI: 7047-9265) among bacteriologically confirmed new cases and retreated patients nationwide in 2018. Conclusion: The prevalence of RR-TB and MDR-TB among new cases and retreated patients in 2018 decreased significantly while compared with that of the 2007—2008 baseline survey. However, due to the large number of population, China is still a country with high burden of drug resistant tuberculosis. It is suggested that comprehensive measures should be taken to reduce the emergence and spread of drug resistant tuberculosis, and then to reduce the overall burden of drug resistant tuberculosis in China.

Key words: Tuberculosis, pulmonary, Mycobacterium tuberculosis, Drug resistance