Investigations

Drug resistance characteristics and treatment strategies of TB patients in three age groups in Guangdong Province from 2014 to 2020

  • Wenji ZHUO ,
  • Ran WEI ,
  • Yanmei CHEN ,
  • Xunxun CHEN ,
  • Meiling YU ,
  • Huixin GUO ,
  • Hongdi LIANG ,
  • Jing LIANG ,
  • Xiaoyu. LAI
Expand
  • *.Centre for Tuberculosis Control of Guangdong Province,Guangzhou 510630,China

Received date: 2023-11-03

  Online published: 2024-03-26

Abstract

Objective To evalute the drug resistance characteristics of tuberculosis(TB) patients of all ages in Guangdong Province during 2014-2020, and provide prevention and treatment strategies of tuberculosis. Method We used 39,048 clinical isolates of Mycobacterium tuberculosis (MTB) belonging to patients with confirmed TB from 2014 to 2020, from 32 TB drug?resistant surveillance sites in Guangdong Province, and we retrospectively analyzed the laboratories data of patients with drug?resistant TB, and grouped patients by age and region, to explore the trend of drug?resistance of MTB clinical isolates, the trend and incidence differences of multi?resistant TB (including monodrug?resistant TB (MR?TB), polydrug?resistant TB (PDR?TB), multidrug?resistant TB (MDR?TB) and extensively drug?resistant TB (XDR?TB)), and resistance characteristics of MTB clinical isolates to drugs in focus (rifampicin and ofloxacin). Result The differences in the resistance rates of MTB clinical isolates to nine antituberculosis drugs among patients at 32 TB drug resistance surveillance sites in Guangdong Province from 2014 to 2020 were not statistically significant (P > 0.05). The rates of MR?TB, PDR?TB, MDR?TB, XDR?TB, and total resistance isolates of MTB clinical isolates were 14.46%, 5.16%, 5.16%, 4.58%, and 1.29%, respectively. he pediatric group had a higher MR rate (15.4%) than the adult and geriatric groups, while the adult and geriatric groups had higher MDR rates (5.0% and 5.0%, respectively). The geriatric group also had a higher XDR rate (2.1%), with statistically significant differences (P < 0.001). The rates of MR?TB (14.8%), PDR?TB (5.3%), MDR?TB (4.7%), XDR?TB (1.4%), ofloxacin resistance (11.33%) and rifampicin resistance (6.92%) of MTB clinical isolates were higher in patients from the Pearl River Delta than in other regions of Guangdong Province, with statistically significant differences (P < 0.001). Conclusion According to the data from the surveillance sites, the epidemiological trend of drug?resistant TB in Guangdong Province is leveling off during the period 2014?2020. However, the incidence of drug?resistant TB is higher in specific populations (e.g. children and the elderly), and the incidence of drug?resistant TB and the rate of drug resistance to drugs in focus are higher in the Pearl River Delta than in other regions of Guangdong Province, necessitating further investigation and the development of novel prevention and control strategies.

Cite this article

Wenji ZHUO , Ran WEI , Yanmei CHEN , Xunxun CHEN , Meiling YU , Huixin GUO , Hongdi LIANG , Jing LIANG , Xiaoyu. LAI . Drug resistance characteristics and treatment strategies of TB patients in three age groups in Guangdong Province from 2014 to 2020[J]. The Journal of Practical Medicine, 2024 , 40(5) : 702 -707 . DOI: 10.3969/j.issn.1006-5725.2024.05.019

References

1 BAGCCHI S. WHO's Global Tuberculosis Report 2022[J]. Lancet Microbe, 2023,4(1):e20. doi:10.1016/s2666-5247(22)00359-7
2 CHEN Y, LIU J, ZHANG Q, et al.Epidemiological features and temporal trends of HIV-negative tuberculosis burden from 1990 to 2019: a retrospective analysis based on the Global Burden of Disease Study 2019[J]. BMJ Open, 2023,13(9):e074134. doi:10.1136/bmjopen-2023-074134
3 DOMíNGUEZ J, BOEREE M J, CAMBAU E,et al. TBnet and RESIST-TB networks. Clinical implications of molecular drug resistance testing for Mycobacterium tuberculosis: a 2023 TBnet/RESIST-TB consensus statement[J]. Lancet Infect Dis, 2023,23(4):e122-e137. doi:10.1016/s1473-3099(22)00875-1
4 赵雁林, 逢宇. 结核病实验室检验规程[M]. 北京:人民卫生出版社, 2015:18-65.
5 World Health Organization. Technical manual for drug susceptibility testing of medicines used in the treatment of tuberculosis[M]. Global Tuberculosis Programme, 2018.
6 VINEY K, LINH N N, GEGIA M, et al. New definitions of pre-extensively and extensively drug-resistant tuberculosis: update from the World Health Organization[J]. Eur Respir J, 2021,57(4):2100361. doi:10.1183/13993003.00361-2021
7 MENZIES R, HOPEWELL K, NUNN P, et al. Monitoring During Treatment in: Treatment of Tuberculosis Guidelines. 4 Ed[C]. TNO, 2010.
8 田鹏,李娜娜,刘梅,等. 遵义地区303例肺结核患者微孔板药敏结果的耐药模式分析[J]. 遵义医科大学学报, 2023,46(7):684-691.
9 马广仁,曹佳伟,林梅,等. 青岛市结核病患者2016-2021年结核分枝杆菌耐药情况分析[J]. 精准医学杂志, 2022,37(5):418-421.
10 MUSHTAQ F, RAZA S M, AHMAD A, et al. Antimicrobial drug resistant features of Mycobacterium tuberculosis associated with treatment failure[J]. PLoS One, 2023,18(10):e0293194. doi:10.1371/journal.pone.0293194
11 GHODOUSI A, TAGLIANI E, KARUNARATNE E, et al. Isoniazid Resistance in Mycobacterium tuberculosis Is a Heterogeneous Phenotype Composed of Overlapping MIC Distributions with Different Underlying Resistance Mechanisms[J]. Antimicrob Agents Chemother, 2019,63(7):e00092-19. doi:10.1128/aac.00092-19
12 YUEN L K, LESLIE D, COLOE P J. Bacteriological and molecular analysis of rifampin-resistant Mycobacterium tuberculosis strains isolated in Australia[J]. J Clin Microbiol, 1999,37(12):3844-3850. doi:10.1128/jcm.37.12.3844-3850.1999
13 WILLIAMS D L, SPRING L, COLLINS L, et al. Contribution of rpoB mutations to development of rifamycin cross-resistance in Mycobacterium tuberculosis[J]. Antimicrob Agents Chemother, 1998,42(7):1853-1857. doi:10.1128/aac.42.7.1853
14 REKART M L, AUNG A, CULLIP T, et al. Household drug-resistant TB contact tracing in Tajikistan[J]. Int J Tuberc Lung Dis, 2023,27(10):748-753. doi:10.5588/ijtld.23.0066
15 VERMA A K, YADAV R N, KUMAR G, et al. Multidrug-resistant and extensively drug-resistant Mycobacterium tuberculosis strains in geriatrics: An analysis and its implications in tuberculosis control[J]. J Clin Tuberc Other Mycobact Dis, 2022,27:100317. doi:10.1016/j.jctube.2022.100317
16 AN Q, SONG W, LIU J, et al. Primary Drug-Resistance Pattern and Trend in Elderly Tuberculosis Patients in Shandong, China, from 2004 to 2019[J]. Infect Drug Resist, 2020,13:4133-4145. doi:10.2147/idr.s277203
17 SHARLING L, MARKS S M, GOODMAN M, et al. Rifampin-resistant Tuberculosis in the United States, 1998-2014[J]. Clin Infect Dis, 2020,70(8):1596-1605. doi:10.1093/cid/ciz491
18 ROELENS M, BATTISTA MIGLIORI G, ROZANOVA L, et al. Evidence-based Definition for Extensively Drug-Resistant Tuberculosis[J]. Am J Respir Crit Care Med, 2021,204(6):713-722. doi:10.1164/rccm.202009-3527oc
19 CHE Y, SONG Q, YANG T, et al. Fluoroquinolone resistance in multidrug-resistant Mycobacterium tuberculosis independent of fluoroquinolone use[J]. Eur Respir J, 2017,50(6):1701633. doi:10.1183/13993003.01633-2017
20 MIRZAYEV F, VINEY K, LINH N N, et al. World Health Organization recommendations on the treatment of drug-resistant tuberculosis, 2020 update[J]. Eur Respir J, 2021,57(6):2003300. doi:10.1183/13993003.03300-2020
21 HAMEED H M A, TAN Y, ISLAM M M, et al. Phenotypic and genotypic characterization of levofloxacin- and moxifloxacin-resistant Mycobacterium tuberculosis clinical isolates in southern China[J]. J Thorac Dis, 2019,11(11):4613-4625. doi:10.21037/jtd.2019.11.03
22 MODONGO C, BARILAR I, WANG Q, et al. Tuberculosis Variant with Rifampin Resistance Undetectable by Xpert MTB/RIF, Botswana[J]. Emerg Infect Dis, 2023,29(11):2403-2406. doi:10.3201/eid2911.230987
Outlines

/