Strategy-analysis of drug-resistant tuberculosis screening based on all suspected tuberculosis patients of Liuzhou City, Guangxi, 2019—2020

doi:10.19982/j.issn.1000-6621.20240121

Abstract

Abstract:

Objective: To understand the situation of drug-resistant tuberculosis (DR-TB) screening in all suspected TB patients in Liuzhou, Guangxi, and to provide a scientific basis for further optimization of screening strategies. Methods: A prospective study was conducted by selecting 6050 suspected tuberculosis patients from 5 urban districts (Chengzhong, Yufeng, Liunan, Liubei, Liujiang) and 5 counties (Liucheng, Luzhai, Rongshui, Rong’an, Sanjiang) in Liuzhou, from January 1st, 2019 to December 31st, 2020, in the Tuberculosis Report of Infectious Disease Surveillance System of the National Center for Disease Control and Prevention,using molecular biology techniques and phenotypic antimicrobial susceptibility test to screen for drug resistance in 2943 strains identified as Mycobacterium tuberculosis complex (MTBC), including 2514 strains in new patients and 429 strains in patients from drug-resistant high-risk groups, and the epidemiological characteristics of DR-TB and the clinical effectiveness of the two detection techniques were analyzed. Results: Of the 6050 suspected tuberculosis patients, the etiologically positive rate was 52.23% (3160/6050), the drug resistance screening rate of the etiologically positive patients was 93.13% (2943/3160), and a total of 132 strains of DR-TB were detected from 2943 strains of MTBC, with a drug-resistance detection rate of 4.49% (132/2943), among which, rifampicin-resistant tuberculosis (RR-TB) was 2.04% (60/2943), multidrug-resistant tuberculosis (MDR-TB) was 2.38% (70/2943), and extensively drug-resistant tuberculosis (XDR-TB) was 0.07% (2/2943); drug-resistant detection rate in high-risk groups (12.59% (54/429)) was significantly higher than that of new patients (3.10% (78/2514), χ²=76.954, P<0.001). Among high-risk groups, drug resistance detection rate was highest in relapsed patients (32.65% (32/98)), significantly higher than that in relapsed treatment failure patients (2.63% (2/76), χ²=44.106, P<0.001). Epidemiological characteristics of DR-TB patients showed that drug-resistance rates of patients aged 65 years or older, retired, from high-risk groups, patients with a history of smoking, alcohol consumption or diabetes mellitus (5.92% (58/979), 8.22% (12/146), 12.59% (54/429), 43.81% (46/105), 38.13% (53/139), 66.67% (12/18)) were significant higher than patients aged 18-64 years, being farmers, new patients, without history of smoking, alcohol consumption and diabetes mellitus (3.98% (72/1810), 4.10% (91/2221), 3.10% (78/2514), 3.03% (86/2838), 2.82% (79/2804), and 4.10% (120/2925), χ² values were 9.471, 10.061, 76.954, 393.038, 385.474, and 163.457, P values were 0.009, 0.039, <0.001, <0.001, <0.001, and <0.001, respectively). Conclusion: The drug-resistant detection rates in etiologically positive tuberculosis patients and high-risk groups in Liuzhou, Guangxi, were both lower than those were required by the World Health Organization. Patients being old and weak, retired, having bad behavioral habits or history of diabetes mellitus were all high-risk factors for developing DR-TB. It is recommended to enhance health education among etiologically positive patients and drug-resistant screening among drug-resistant high-risk groups. Simultaneously using both molecular biology techniques and phenotypic antimicrobial susceptibility test for drug resistance screening could significantly improve screening accuracy and diagnosis timeliness.

Key words: Tuberculosis, pulmonary, Tuberculosis, multidrug-resistant, Health services research, Population monitoring

CLC Number:

R521
R195

Liang Yuexin, Liu Aimei, Zeng Huipin, Huang Lihua, Lyu Liuying, Zeng Xinyan, Li Liyuan, Huang Junli. Strategy-analysis of drug-resistant tuberculosis screening based on all suspected tuberculosis patients of Liuzhou City, Guangxi, 2019—2020[J]. Chinese Journal of Antituberculosis, 2024, 46(8): 958-966. doi: 10.19982/j.issn.1000-6621.20240121

Figures/Tables 6

References 24

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人口学特征	患者例数 (2943例)	耐药患者(132例)		非耐药患者(2811例)		χ²值	P值
人口学特征	患者例数 (2943例)	例数	构成比(%)	例数	构成比(%)	χ²值	P值
性别						0.019	0.891
男性	2222	99	4.46	2123	95.54
女性	721	33	4.58	688	95.42
年龄组(岁)						9.471	0.009
0~17	154	2	1.30	152	98.70
18~64	1810	72	3.98	1738	96.02
65~83	979	58	5.92	921	94.08
职业						10.061	0.039
离退休	146	12	8.22	134	91.78
家政/家务	334	21	6.29	313	93.71
干部/工人	72	4	5.56	68	94.44
农民	2221	91	4.10	2130	95.90
其他职业	170	4	2.35	166	97.65
民族						7.890	0.096
汉族	1272	71	5.58	1201	94.42
壮族	1162	46	3.96	1116	96.04
侗族	147	6	4.08	141	95.92
苗族	172	5	2.91	167	97.09
其他民族	190	4	2.11	186	97.89
居住地区						0.270	0.603
城区	1585	74	4.67	1511	95.33
县城	1358	58	4.27	1300	95.93
患者类型						76.954	<0.001
新发	2514	78	3.10	2436	96.90
高危人群	429	54	12.59	375	87.41
吸烟史						393.038	<0.001
有	105	46	43.81	59	56.19
无	2838	86	3.03	2752	96.97
饮酒史						385.474	<0.001
有	139	53	38.13	86	61.87
无	2804	79	2.82	2725	97.18
糖尿病史						163.457	<0.001
有	18	12	66.67	6	3.33
无	2925	120	4.10	2805	95.90

患者类型	分子生物学检测			表型药敏试验
患者类型	筛查例数	耐药例数	检出率(%)	筛查例数	耐药例数	检出率(%)
新发患者	2160	65	3.01	1995	50	2.51
高危人群	354	45	12.71	238	36	15.13
合计	2514	110	4.38	2233	86	3.85

患者类别	结核病患者 (例)	非耐药患者[例 (构成比,%)]	耐药肺结核患者[例(构成比,%)]
患者类别	结核病患者 (例)	非耐药患者[例 (构成比,%)]	XDR-TB	MDR-TB	RR-TB	合计
新发患者	2514	2436(96.90)	2(0.08)	36(1.43)	40(1.59)	78(3.10)
高危人群	429	375(87.41)	0(0.00)	34(7.93)	20(4.66)	54(12.59)
合计	2943	2811(95.51)	2(0.07)	70(2.38)	60(2.04)	132(4.49)

患者分类	高危人群[例 (构成比,%)]	耐药肺结核患者[例(检出率,%)]
患者分类	高危人群[例 (构成比,%)]	MDR-TB(34例)	RR-TB(20例)	小计(54例)
初治失败	72(16.78)	1(1.39)	1(1.39)	2(2.78)
返回	79(18.42)	4(5.06)	4(5.06)	8(10.13)
复发	98(22.84)	20(20.41)	12(12.24)	32(32.65)
复治失败	76(17.72)	2(2.63)	0(0.00)	2(2.63)
其他	104(24.24)	7(6.73)	3(2.89)	10(9.62)
合计	429(100.00)	34(7.93)	20(4.66)	54(12.59)

地区	例数	非耐药患者		耐药患者
地区	例数	例数	构成比(%)	例数	构成比(%)
柳南区	234	210	89.74	24	10.26
柳江区	735	712	96.87	23	3.13
鱼峰区	363	352	96.97	11	3.03
柳北区	184	175	95.11	9	4.89
城中区	69	62	89.86	7	10.14
鹿寨县	382	372	97.38	10	2.62
融安县	134	129	96.27	5	3.73
柳城县	368	350	95.11	18	4.89
融水苗族自治县	295	281	95.25	14	4.75
三江侗族自治县	179	168	93.85	11	6.15
合计	2943	2811	95.51	132	4.49