A longitudinal study on the characteristics of diagnosis and treatment service of multidrug-resistant/rifampicin resistant pulmonary tuberculosis from 2009 to 2020 in Nantong City, Jiangsu Province

doi:10.19982/j.issn.1000-6621.20230058

Abstract

Abstract:

Objective: To describe the longitudinal changes of case finding, clinical features and treatment for multidrug-resistant/rifampicin-resistant pulmonary tuberculosis (MDR/RR-PTB) in Nantong City, Jiangsu Province from 2009 to 2020, and to provide scientific guidance for optimizing the prevention and treatment policies for MDR/RR-PTB. Methods: Based on the Tuberculosis Information Management System, we collected the associated data of MDR/RR-PTB patients registered from 2009—2020 in Nantong City, Jiangsu Province. Longitudinal changes of detection rate, demographic characteristics, diagnostic delay, treatment coverage and treatment outcome for MDR/RR-PTB patients were depicted. Results: A total of 426 MDR/RR-PTB patients were detected in Nantong from 2009 to 2020. From 2014 to 2020, 4030 patients were screened, with an overall detection rate of 5.43% (219/4030). The detection rate fluctuated slightly over the years in response to different screening policy, from 16.83% (34/202) in 2014 to 2.85% (32/1123) in 2020, with a significantly decline trend (Z_trend=-11.541, P<0.001). During the past 12 years, the proportion of newly treated MDR/RR-PTB patients increased from 0 in 2009 to 53.12% (17/32) in 2020, and the proportion of patients aged ≥80 years decreased from 53.85% (7/13) in 2009 to 3.12% (1/32) in 2020. Overall, the diagnostic delay showed a decreasing trend since 2009, with the number of 97 (78, 207) days in 2009 and 0 (0, 0) day in 2020. As for treatment outcome among those received standardized treatment, the treatment success rate increased from 60.00% (6/10) in 2009 to 71.88% (23/32) in 2020, and the case fatality rate decreased from 20.00% (2/10) in 2009 to 9.38% (3/32) in 2020. Conclusion: This study showed that the detection rate of MDR/RR-PTB steadily decreased and maintained at a low level, while MDR/RR-PTB patients tended to be younger over time in Nantong City, and the proportion of newly treated patients increased annually. Diagnostic delay of MDR/RR-PTB patients tended to decrease. It is recommended to strengthen the standardized management of treatment in patients, especially for RR-PTB patients, to further decrease transmission.

Key words: Tuberculosis, Drug resistance, Institutional practice, Epidemiologic study characteristics as topic, Longitudinal studies

CLC Number:

R521

Che Beibei, Wang Xiaoping, Qiu Qing, Chen Cheng, Zheng Xubin, Zhao Qi, Xu Biao. A longitudinal study on the characteristics of diagnosis and treatment service of multidrug-resistant/rifampicin resistant pulmonary tuberculosis from 2009 to 2020 in Nantong City, Jiangsu Province[J]. Chinese Journal of Antituberculosis, 2023, 45(9): 864-871. doi: 10.19982/j.issn.1000-6621.20230058

Figures/Tables 6

References 25

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年份	筛查人数	应筛查人数	筛查率	MDR-PTB			RR-PTB			MDR/RR-PTB
年份	筛查人数	应筛查人数	筛查率	例数	检出率 (%)	登记率 (/10万)	例数	检出率 (%)	登记率 (/10万)	例数	检出率 (%)	登记率 (/10万)
2009	-	-	-	13	-	0.17	-	-	-	13	-	0.17
2010	-	-	-	73	-	0.96	-	-	-	73	-	0.96
2011	-	-	-	63	-	0.83	-	-	-	63	-	0.83
2012	-	-	-	37	-	0.48	-	-	-	37	-	0.48
2013	-	-	-	21	-	0.27	-	-	-	21	-	0.27
2014	202	204	99.02	34	16.83	0.44	-	-	-	34	16.83	0.44
2015	171	175	97.71	27	15.79	0.35	-	-	-	27	15.79	0.35
2016	230	230	100.00	27	11.74	0.35	-	-	-	27	11.74	0.35
2017	187	188	99.47	26	13.90	0.34	4	2.14	0.05	30	16.04	0.39
2018	1087	1169	92.99	19	1.75	0.25	16	1.47	0.21	35	3.22	0.46
2019	1030	1050	98.10	12	1.17	0.16	22	2.14	0.29	34	3.30	0.45
2020	1123	1145	98.08	11	0.98	0.14	21	1.87	0.28	32	2.85	0.42
合计	4030	4161	96.85	363	3.87	0.40	63	1.84	0.21	426	5.43	0.46

特征		合计 (426例)		2009年 (13例)		2010年 (73例)		2011年 (63例)		2012年 (37例)		2013年 (21例)		2014年 (34例)		2015年 (27例)		2016年 (27例)		2017年 (30例)		2018年 (35例)		2019年 (34例)	2020年 (32例)
性别
男性		325 (76.29)		10 (76.92)		53 (72.60)		52 (82.54)		29 (78.38)		15 (71.43)		26 (76.47)		22 (81.48)		18 (66.67)		23 (76.67)		31 (88.57)		22 (64.71)	24 (75.00)
女性		101 (23.71)		3 (23.08)		20 (27.40)		11 (17.46)		8 (21.62)		6 (28.57)		8 (23.53)		5 (18.52)		9 (33.33)		7 (23.33)		4 (11.43)		12 (35.29)	8 (25.00)
年龄组(岁)
<35		50 (11.74)		0 (0.00)		2 (2.74)		1 (1.59)		5 (13.51)		1 (4.76)		2 (5.88)		4 (14.81)		4 (14.81)		6 (20.00)		8 (22.86)		11 (32.35)	6 (18.75)
35~49		64 (15.02)		2 (15.38)		12 (16.44)		10 (15.87)		4 (10.81)		3 (14.29)		4 (11.76)		2 (7.41)		5 (18.52)		5 (16.67)		5 (14.29)		5 (14.71)	7 (21.88)
50~59		85 (19.95)		2 (15.38)		15 (20.55)		6 (9.52)		4 (10.81)		7 (33.33)		8 (23.53)		9 (33.33)		8 (29.63)		6 (20.00)		8 (22.86)		6 (17.65)	6 (18.75)
60~69		105 (24.65)		2 (15.38)		18 (24.66)		19 (30.16)		10 (27.03)		6 (28.57)		9 (26.47)		4 (14.81)		5 (18.52)		6 (20.00)		8 (22.86)		9 (26.47)	9 (28.13)
70~79		66 (15.49)		0 (0.00)		13 (17.81)		14 (22.22)		9 (24.32)		3 (14.29)		3 (8.82)		8 (29.63)		4 (14.81)		4 (13.33)		3 (8.57)		2 (5.88)	3 (9.38)
≥80		56 (13.15)		7 (53.85)		13 (17.81)		13 (20.63)		5 (13.51)		1 (4.76)		8 (23.53)		0 (0.00)		1 (3.70)		3 (10.00)		3 (8.57)		1 (2.94)	1 (3.12)
职业
农民	367 (86.15)		11 (84.62)		67 (91.78)		57 (90.48)		32 (86.49)		20 (95.24)		32 (94.12)		24 (88.89)		21 (77.78)		29 (96.67)		27 (77.14)		23 (67.65)		24 (75.00)
其他职业	59 (13.85)		2 (15.38)		6 (8.22)		6 (9.52)		5 (13.51)		1 (4.76)		2 (5.88)		3 (11.11)		6 (22.22)		1 (3.33)		8 (22.86)		11 (32.35)		8 (25.00)
登记类型
初治	157 (36.85)		0 (0.00)		8 (10.96)		8 (12.70)		14 (37.84)		7 (33.33)		11 (32.35)		15 (55.56)		16 (59.26)		19 (63.33)		21 (60.00)		21 (61.76)		17 (53.12)
复治	269 (63.15)		13 (100.00)		65 (89.04)		55 (87.30)		23 (62.16)		14 (66.67)		23 (67.65)		12 (44.44)		11 (40.74)		11 (36.67)		14 (40.00)		13 (38.24)		15 (46.88)

治疗情况	总计 (426例)	2009年 (13例)	2010年 (73例)	2011年 (63例)	2012年 (37例)	2013年 (21例)	2014年 (34例)	2015年 (27例)	2016年 (27例)	2017年 (30例)	2018年 (35例)	2019年 (34例)	2020年 (32例)
纳入治疗	317(74.41)	10(76.92)	62(84.93)	39(61.90)	28(75.68)	15(71.43)	23(67.65)	15(55.56)	19(70.37)	16(53.33)	29(82.86)	29(85.29)	32(100.00)
维持原方案	32(7.51)	0(0.00)	0(0.00)	1(1.59)	1(2.70)	0(0.00)	4(11.76)	10(37.04)	4(14.81)	7(23.33)	1(2.86)	4(11.76)	0(0.00)
拒治	19(4.46)	0(0.00)	2(2.74)	9(14.29)	2(5.41)	1(4.76)	2(5.88)	0(0.00)	2(7.41)	1(3.33)	0(0.00)	0(0.00)	0(0.00)
病亡	24(5.63)	0(0.00)	5(6.85)	2(3.17)	6(16.22)	1(4.76)	4(11.76)	0(0.00)	1(3.70)	3(10.00)	2(5.71)	0(0.00)	0(0.00)
失访	1(0.23)	0(0.00)	0(0.00)	1(1.59)	0(0.00)	0(0.00)	0(0.00)	0(0.00)	0(0.00)	0(0.00)	0(0.00)	0(0.00)	0(0.00)
其他	33(7.75)	3(23.08)	4(5.48)	11(17.46)	0(0.00)	4(19.05)	1(2.94)	2(7.41)	1(3.70)	3(10.00)	3(8.57)	1(2.94)	0(0.00)

治疗结局	合计 (317例)	2009年 (10例)	2010年 (62例)	2011年 (39例)	2012年 (28例)	2013年 (15例)	2014年 (23例)	2015年 (15例)	2016年 (19例)	2017年 (16例)	2018年 (29例)	2019年 (29例)	2020年 (32例)
治疗成功	177(55.84)	6(60.00)	28(45.16)	18(46.15)	14(50.00)	8(53.33)	14(60.87)	9(60.00)	10(52.63)	12(75.00)	18(62.07)	17(58.62)	23(71.88)
失败	37(11.67)	0(0.00)	12(19.35)	6(15.38)	6(21.43)	2(13.33)	1(4.35)	1(6.67)	2(10.53)	0(0.00)	3(10.34)	4(13.79)	0(0.00)
病亡	38(11.99)	2(20.00)	10(16.13)	4(10.26)	5(17.86)	1(6.67)	6(26.09)	1(6.67)	2(10.53)	0(0.00)	2(6.90)	2(6.90)	3(9.38)
失访	37(11.67)	2(20.00)	10(16.13)	6(15.38)	1(3.57)	2(13.33)	2(8.70)	3(20.00)	2(10.53)	1(6.25)	1(3.45)	3(10.34)	4(12.50)
其他	28(8.83)	0(0.00)	2(3.23)	5(12.82)	2(7.14)	2(13.33)	0(0.00)	1(6.67)	3(15.79)	3(18.75)	5(17.24)	3(10.34)	2(6.25)