Analysis of drug resistance in clinical isolates from 610 elderly tuberculosis patients

doi:10.19982/j.issn.1000-6621.20240181

Abstract

Abstract:

Objective: To analyze the drug resistance characteristics of clinical isolates of Mycobacterium tuberculosis (MTB) in elderly tuberculosis patients (≥60 years old) in a tuberculosis designated hospital in Lishui City, Zhejiang Province, China, offering insights for the prevention and control of drug-resistant tuberculosis in the elderly population of the region. Methods: Information on clinical isolates and samples from elderly tuberculosis patients visiting the Lishui Regional Tuberculosis Sentinel Hospital from 2018 to 2023 was collected. Resistance to first-line antituberculosis drugs (streptomycin, isoniazid, rifampicin, ethambutol) was detected using BACTEC MGIT 960 liquid drug susceptibility test and resistance characteristics were analyzed. Results: A total of 610 strains of MTB were included in the drug resistance detection and analysis. The overall drug resistance rate was 18.85% (115/610), and the multidrug resistance rate was 6.07% (37/610). The drug resistance rate of male patients was 19.38% (93/480), and that of female patients was 16.92% (22/130), with no statistically significant difference (χ²=0.402, P>0.05). The drug resistance rate among initial treatment patients was 18.18% (98/539), and that of retreated patients was 23.94% (17/71). Among them, the ethambutol resistance rate among retreated patients (8.45% (6/71)) was significantly higher than that among initial treatment patients (2.78% (15/539), χ²=6.063, P<0.05). The resistance rates for different drugs ranked as: isoniazid (14.59%, 89/610), streptomycin (8.85%, 54/610), rifampicin (7.38%,45/610), and ethambutol (3.44%, 21/610). The drug resistance patterns showed a total of 13 different drug resistance combinations. Among multidrug resistance combinations, the highest drug resistance rate was for “isoniazid+rifampicin+streptomycin”(2.62%,16/610). The drug resistance rate was 20.00% (19/95) in 2018 and 17.83% (23/129) in 2023, with no statistically significant difference for changing trend ( $χ t r e n d 2$ =1.792, P>0.05). Conclusion: The drug resistance rate of MTB in elderly tuberculosis patients in Lishui Region has decreased in the past years, but the drug resistance situation is still severe.

Key words: Mycobacterium tuberculosis, The elderly, Tuberculosis, multidrug-resistant, Medicine sensitiveness test

CLC Number:

R52
R446.5

Xu Henan, Lai Congjuan, Zhang Zunjing, Guo Jing, Xu Lixia, Zhang Ying, Liu Zhongda. Analysis of drug resistance in clinical isolates from 610 elderly tuberculosis patients[J]. Chinese Journal of Antituberculosis, 2024, 46(12): 1490-1495. doi: 10.19982/j.issn.1000-6621.20240181

Figures/Tables 3

年度	单耐药率(%)	耐多药率(%)	多耐药率(%)	总耐药率(%)
2018	10.53(10/95)	7.37(7/95)	2.11(2/95)	20.00(19/95)
2019	7.53(7/93)	4.30(4/93)	0.00(0/93)	11.83(11/93)
2020	6.54(7/107)	5.61(6/107)	2.80(3/107)	14.95(16/107)
2021	8.25(8/97)	7.22(7/97)	3.09(3/97)	18.56(18/97)
2022	13.48(12/89)	6.74(6/89)	11.24(10/89)	31.46(28/89)
2023	10.85(14/129)	5.43(7/129)	1.55(2/129)	17.83(23/129)
$χ 趋势 2$ 值	0.753	0.009	2.688	1.792
P值	0.385	0.923	0.101	0.181

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特征	总菌株数	耐药		单耐药		多耐药		耐多药		链霉素		异烟肼		利福平		乙胺丁醇
特征	总菌株数	耐药数 (株)	耐药率 (%)	耐药数 (株)	耐药率 (%)	耐药数 (株)	耐药率 (%)	耐药数 (株)	耐药率 (%)	耐药数 (株)	耐药率 (%)	耐药数 (株)	耐药率 (%)	耐药数 (株)	耐药率 (%)	耐药数 (株)	耐药率 (%)
性别
男性	480	93	19.38	46	9.58	15	3.13	32	6.67	44	9.17	73	15.21	39	8.13	16	3.33
女性	130	22	16.92	12	9.23	5	3.85	5	3.85	10	7.69	16	12.31	6	4.62	5	3.85
χ²值		0.402		0.015		0.168		1.428		0.276		0.691		1.844		0.081
P值		0.526		0.903		0.682		0.232		0.600		0.406		0.174		0.776
治疗类型
初治	539	98	18.18	50	9.28	16	2.97	32	5.94	44	8.16	77	14.29	39	7.24	15	2.78
复治	71	17	23.94	8	11.27	4	5.63	5	7.04	10	14.08	12	16.90	6	8.45	6	8.45
χ²值		1.361		0.289		1.405		0.135		2.726		0.344		0.136		6.063
P值		0.243		0.591		0.236		0.714		0.099		0.557		0.713		0.014
年龄组(岁)
60~69	269	57	21.19	28	10.41	11	4.09	18	6.69	28	10.41	40	14.87	24	8.92	13	4.83
70~79	185	34	18.38	15	8.11	5	2.70	14	7.57	16	8.65	29	15.68	15	8.11	4	2.16
80~89	134	21	15.67	12	8.96	4	2.99	5	3.73	9	6.72	19	14.18	6	4.48	3	2.24
≥90	22	3	13.64	3	13.64	0	0.00	0	0.00	1	4.55	1	4.55	0	0.00	1	4.55
χ²值		2.265		1.158		1.153		3.619		2.081		1.991		4.485		3.141
P值		0.519		0.763		0.675		0.306		0.556		0.574		0.214		0.370
合计	610	115	18.85	58	9.51	20	3.28	37	6.07	54	8.85	89	14.59	45	7.38	21	3.44

耐药谱	初治(539株)		复治(71株)		合计(610株)
耐药谱	耐药株数	耐药率(%)	耐药株数	耐药率(%)	耐药株数	耐药率(%)
单耐药	50	9.28	8	11.27	58	9.51
链霉素	9	1.67	3	4.23	12	1.97
异烟肼	31	5.75	4	5.63	35	5.74
利福平	6	1.11	0	0.00	6	0.98
乙胺丁醇	4	0.74	1	1.41	5	0.82
多耐药	16	2.97	4	5.63	20	3.28
异烟肼+链霉素	11	2.04	2	2.82	13	2.13
异烟肼+乙胺丁醇	2	0.37	0	0.00	2	0.33
利福平+乙胺丁醇	0	0.00	1	1.41	1	0.16
链霉素+乙胺丁醇	1	0.19	0	0.00	1	0.16
异烟肼+乙胺丁醇+链霉素	1	0.19	1	1.41	2	0.33
乙胺丁醇+利福平+链霉素	1	0.19	0	0.00	1	0.16
耐多药	32	5.94	5	7.04	37	6.07
异烟肼+利福平	11	2.04	1	1.41	12	1.97
异烟肼+利福平+链霉素	15	2.78	1	1.41	16	2.62
异烟肼+利福平+乙胺丁醇+链霉素	6	1.11	3	4.23	9	1.48