Analysis of Mycobacterium tuberculosis drug resistance monitoring in Anhui Province from 2016 to 2022

doi:10.19982/j.issn.1000-6621.20240029

Abstract

Abstract:

Objective: To analyze the change trend of drug resistance spectrum of Mycobacterium tuberculosis isolated from four national drug resistance monitoring sites in Anhui Province from 2016 to 2022, and then to understand the prevalence and control effect of tuberculosis and drug-resistant tuberculosis in Anhui Province. Methods: A total of 3073 laboratory-confirmed pulmonary tuberculosis patients, who were continuously enrolled from four drug resistance surveillance sites between 2016 and 2022, were included in the study. General information of the patients was collected, and sputum specimens were collected for isolation and cultured. Strain identification was performed on the cultured isolates, and a total of 2336 strains of Mycobacterium tuberculosis were obtained. Drug susceptibility testing was performed on the Mycobacterium tuberculosis strains using the proportion method for six anti-tuberculosis drugs (isoniazid (INH), rifampicin (RFP), streptomycin (Sm), ethambutol (EMB), ofloxacin (Ofx), and kanamycin (Km). Results: Among the 2336 strains of Mycobacterium tuberculosis, 1893 strains (81.04%) were sensitive to all the six anti-tuberculosis drugs, and 443 strains were resistant to at least one or more anti-tuberculosis drugs, with a drug resistance rate of 18.96% (443/2336), of which 16.80% (348/2071) were newly treated, 35.85% (95/265) were retreated, and 98 (4.20%) were multidrug resistant. Among the six anti-tuberculosis drugs, the prevalence of single resistance to anti-tuberculosis drugs were decreased from INH (10.55%, 236/2336) to Sm (8.18%, 183/2336), Ofx (6.53%, 146/2336), RFP (5.95%, 133/2336), EMB (2.37%, 53/2336), Km (1.97%, 44/2336). The resistance rates to Ofx, INH, EMB and Km showed a downward trend from 2016 to 2022 (the resistance rates of Ofx, INH, EMB and Km were 10.49% (30/286), 12.24% (35/286), 1.75% (5/286) and 2.45% (7/286) in 2016, respectively; 3.89% (18/463), 9.29% (43/463), 0.86% (4/463), 1.08% (5/463) in 2022); $χ_{rend}^2$ values were 16.964, 15.989, 15.798, and 26.075, respectively, all Ps<0.05). The drug resistance rate and multidrug-resistance rate of newly diagnosed patients (22.76% (56/246) and 6.50% (16/246) in 2016, 14.15% (60/424) and 1.89% (8/424) in 2022) also showed a downward trend ($χ_{rend}^2$=14.445, 16.688, All Ps<0.05). Among different age groups, the drug resistance rate of Mycobacterium tuberculosis strains in the 40-59 years old group was the highest (22.74%, 146/642). Conclusion: The situation of drug resistance tuberculosis is still serious in Anhui province. More attention should be paid to drug resistance in retreatment patients, people aged 40-59 years and patients living in urban areas.

Key words: Mycobacterium tuberculosis, Drug resistance, bacterial, Population surveillance

CLC Number:

R52
R183.3

Bao Xundi, Liang Suo, Li Jun, Ye Qian, Wu Dandan, Wang Shu, LI Yue, Ding Yunsheng, Liu Jie. Analysis of Mycobacterium tuberculosis drug resistance monitoring in Anhui Province from 2016 to 2022[J]. Chinese Journal of Antituberculosis, 2024, 46(5): 531-537. doi: 10.19982/j.issn.1000-6621.20240029

Figures/Tables 4

耐药类型	合计		初治		复治		χ²值	P值
耐药类型	耐药菌株数	耐药率 (%)	耐药菌株数	耐药率 (%)	耐药菌株数	耐药率 (%)	χ²值	P值
单一耐药
INH	236	10.55	177	8.55	59	22.26	48.677	0.000
RFP	133	5.95	86	4.15	47	17.74	80.731	0.000
Sm	183	8.18	142	6.86	41	15.47	24.150	0.000
EMB	53	2.37	32	1.55	21	7.92	43.120	0.000
Km	44	1.97	33	1.59	11	4.15	8.315	0.004
Ofx	146	6.53	112	5.41	34	12.83	22.088	0.000
耐多药
INH+RFP	98	4.20	60	2.90	38	14.34	76.534	0.000
INH+RFP+Sm	47	2.01	29	1.40	18	6.79	34.648	0.000
INH+RFP+EMB	36	1.54	22	1.06	14	5.28	27.583	0.000
INH+RFP+Km	27	1.16	20	0.97	7	2.64	2.775	0.016
INH+RFP+Ofx	46	1.97	28	1.35	18	6.79	36.023	0.000
INH+RFP+Sm+EMB	29	1.24	17	0.82	12	4.53	26.339	0.000
INH+RFP+Sm+Km	19	0.81	14	0.68	5	1.89	4.269	0.039
INH+RFP+Sm+Ofx	23	0.98	13	0.63	10	3.77	23.849	0.000
INH+RFP+EMB+Km	17	0.73	12	0.58	5	1.89	5.558	0.018
INH+RFP+EMB+Ofx	23	0.98	14	0.68	9	3.40	17.832	0.000
INH+RFP+Sm+EMB+Km	15	0.64	10	0.48	5	1.89	7.258	0.007
INH+RFP+Sm+EMB+Ofx	20	0.86	11	0.53	9	3.40	22.720	0.000
广泛耐药
INH+RFP+Km+Ofx	20	0.86	13	0.63	7	2.64	11.224	0.001
INH+RFP+Sm+Km+Ofx	15	0.64	10	0.48	5	1.89	7.258	0.007
INH+RFP+EMB+Km+Ofx	13	0.56	10	0.48	5	1.89	7.258	0.007
INH+RFP+Sm+EMB+Km+Ofx	13	0.56	8	0.39	5	1.89	9.558	0.002
多耐药
INH+Sm	96	4.11	70	3.38	26	9.81	24.659	0.000
INH+EMB	44	1.88	26	1.26	18	6.79	38.975	0.000
INH+Km	33	1.41	26	1.26	7	2.64	3.241	0.072
INH+Ofx	55	2.35	35	1.69	20	7.55	35.058	0.000
Sm+EMB	34	1.46	19	0.92	15	5.66	36.848	0.000
Sm+Km	22	0.94	17	0.82	5	1.89	2.861	0.091
Sm+Ofx	29	1.24	18	0.87	11	4.15	20.638	0.000
EMB+Km	18	0.77	13	0.63	5	1.89	4.871	0.027
EMB+Ofx	28	1.20	16	0.77	12	4.53	27.983	0.000
Km+Ofx	24	1.03	16	0.77	8	3.02	11.658	0.001
INH+Sm+Km	21	0.90	16	0.77	5	1.89	3.274	0.070
INH+Sm+Ofx	25	1.07	15	0.72	10	3.77	20.633	0.000
INH+EMB+Km	18	0.77	13	0.63	5	1.89	4.871	0.027
INH+EMB+Ofx	25	1.07	16	0.77	9	3.40	15.275	0.000
RFP+Sm+Km	20	0.86	15	0.72	5	1.89	3.740	0.053
RFP+Sm+Ofx	25	1.07	15	0.72	10	3.77	20.633	0.000
RFP+EMB+Km	17	0.73	12	0.58	5	1.89	5.558	0.018
RFP+EMB+Ofx	24	1.03	14	0.68	10	3.77	22.169	0.000
INH+Sm+EMB+Km	15	0.64	10	0.48	5	1.89	7.258	0.007
INH+Sm+EMB+Ofx	21	0.90	12	0.58	9	3.40	20.924	0.000
RFP+Sm+EMB+Km	15	0.64	10	0.48	5	1.89	7.258	0.007
RFP+Sm+EMB+Ofx	20	0.86	11	0.53	9	3.40	13.684	0.000

年度	菌株数	耐INH		耐RFP		耐Sm		耐EMB		耐Km		耐Ofx
年度	菌株数	菌株数	耐药率 (%)	菌株数	耐药率 (%)	菌株数	耐药率 (%)	菌株数	耐药率 (%)	菌株数	耐药率 (%)	菌株数	耐药率 (%)
2016	286	35	12.24	24	8.39	30	10.49	5	1.75	7	2.45	30	10.49
2017	288	32	11.11	18	6.25	23	7.99	8	2.78	5	1.74	22	7.64
2018	264	37	14.02	21	7.95	20	7.58	8	3.03	14	5.30	20	7.58
2019	354	42	11.86	21	5.93	36	10.17	14	3.95	8	2.26	22	6.21
2020	332	20	6.02	14	4.22	27	8.13	11	3.31	5	1.51	18	5.42
2021	349	27	7.74	16	4.58	25	7.16	3	0.86	0	0.00	16	4.58
2022	463	43	9.29	19	4.10	22	4.75	4	0.86	5	1.08	18	3.89
$χ 趋势 2$ 值		15.989		10.922		11.852		15.798		26.075		16.964
P值		0.014		0.091		0.065		0.015		0.000		0.009

特征	菌株数	MDR		耐INH		耐RFP		耐Sm		耐EMB		耐Km		耐Ofx
特征	菌株数	菌株数	耐药率 (%)	菌株数	耐药率 (%)	菌株数	耐药率 (%)	菌株数	耐药率 (%)	菌株数	耐药率 (%)	菌株数	耐药率 (%)	菌株数	耐药率 (%)
性别
男性	1788	76	4.25	180	10.07	103	5.76	147	8.22	42	2.35	38	2.13	111	6.21
女性	548	22	4.01	56	10.22	30	5.47	36	6.57	11	2.01	6	1.09	35	6.39
χ²值		0.058		0.011		0.064		1.586		0.413		2.867		0.023
P值		0.810		0.918		0.800		0.208		0.520		0.090		0.880
年龄组(岁)
0~19	39	0	0.00	2	5.13	1	2.56	1	2.56	2	5.13	0	0.00	1	2.56
20~39	354	11	3.11	31	8.76	20	5.65	26	7.34	5	1.41	2	0.56	12	3.39
40~59	642	43	6.70	85	13.24	57	8.88	77	11.99	22	3.43	19	2.96	43	6.70
≥60	1301	44	3.38	118	9.07	55	4.23	79	6.07	24	1.84	23	1.77	90	6.92
χ²值		14.895		10.285		18.049		22.596		7.547		8.195		7.056
P值		0.002		0.016		0.000		0.000		0.056		0.042		0.070
患者分类
初治	2071	60	2.90	177	8.55	86	4.15	142	6.86	32	1.55	33	1.59	112	5.41
复治	265	38	14.34	59	22.26	47	17.74	41	15.47	21	7.92	11	4.15	34	12.83
χ²值		76.534		48.677		80.731		24.150		43.120		8.315		22.088
P值		0.000		0.000		0.000		0.000		0.000		0.004		0.000
是否合并糖尿病
是	285	20	7.02	31	10.88	26	9.12	25	8.77	8	2.81	8	2.81	24	8.42
否	1988	77	3.87	198	9.96	105	5.28	152	7.65	45	2.26	36	1.81	120	6.04
未知	63	1	1.59	7	11.11	2	3.17	6	9.52	0	0.00	0	0.00	2	3.17
χ²值		6.032		0.232		6.772		0.440		0.323		1.303		2.389
P值		0.014		0.630		0.009		0.507		0.570		0.254		0.122
地域来源
城镇	801	44	5.49	104	12.98	62	7.74	82	10.24	17	2.12	20	2.50	65	8.11
农村	1535	54	3.52	132	8.60	71	4.63	101	6.58	36	2.35	24	1.56	81	5.28
χ²值		5.109		11.141		9.511		9.751		0.118		2.481		7.235
P值		0.024		0.001		0.002		0.002		0.731		0.115		0.007
家庭年收入(元)
<20000	661	31	4.69	70	10.59	39	5.90	48	7.26	20	3.03	13	1.97	45	6.81
20001~40000	748	30	4.01	70	9.36	48	6.42	50	6.68	17	2.27	15	2.01	49	6.55
40001~60000	493	23	4.67	58	11.76	30	6.09	49	9.94	7	1.42	11	2.23	26	5.27
>60000	434	14	3.23	38	8.76	16	3.69	36	8.29	9	2.07	5	1.15	26	5.99
χ²值		1.752		2.996		4.178		4.822		3.385		1.664		1.318
P值		0.626		0.392		0.243		0.185		0.336		0.645		0.725

年度	初治患者分离株									复治患者分离株
年度	菌株数	耐药菌株数	耐药率 (%)	耐多药菌株数	耐多药率 (%)	单耐药菌株数	单耐药率 (%)	多耐药菌株数	多耐药率 (%)	菌株数	耐药菌株数	耐药率 (%)	耐多药菌株数	耐多药率 (%)	单耐药菌株数	单耐药率 (%)	多耐药菌株数	多耐药率 (%)
2016	246	56	22.76	5	2.03	35	14.23	16	6.50	40	18	45.00	8	20.00	7	17.50	3	7.50
2017	245	42	17.14	9	3.67	29	11.84	4	1.63	43	15	34.88	7	16.28	7	16.28	1	2.33
2018	231	50	21.65	11	4.76	28	12.12	11	4.76	33	14	42.42	3	9.09	8	24.24	3	9.09
2019	304	48	15.79	11	3.62	28	9.21	9	2.96	50	21	42.00	9	18.00	6	12.00	6	12.00
2020	297	46	15.49	5	1.68	35	11.78	6	2.02	35	11	31.43	5	14.29	4	11.43	2	5.71
2021	324	46	14.20	7	2.16	26	8.02	13	4.01	25	6	24.00	3	12.00	2	8.00	1	4.00
2022	424	60	14.15	12	2.83	40	9.43	8	1.89	39	10	25.64	3	7.69	5	12.82	2	5.13
$χ 趋势 2$ 值		14.445		6.813		8.251		16.688			6.508		3.975		4.322		4.347
P值		0.025		0.338		0.220		0.011			0.369		0.680		0.633		0.630

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