Background: Finding out more predictors of drug-resistant tuberculosis (DR-TB) helps to facilitate TB prevention and control. Previous study had revealed that tobacco smoking and alcohol drinking might be a risk factor for developing drug-resistant tuberculosis. However, few discussed their joint impact on resistance among newly diagnosed TB cases. This study aimed to assess and compare the joint and independent effect of smoking and drinking on TB resistance.Methods: This was a retrospective study of 7996 newly diagnosed TB patients who were collected from Shandong, China from Jan 1, 2004, to Dec 31, 2020, and all had drug susceptibility results, information about smoking and alcohol consumption. Patients were classified into four groups including smoker only(G1), drinker only(G2), smoker+drinker(G3), non-smoker+non-drinker group(G0). We described the drug-resistant profiles, clinical factors and also calculated the ORs of different drug-resistance among G1, G2, G3, compared to G0.Results:Of 7996 TB cases enrolled, the proportions of G1, G2, G3, and G0 were 8.25%, 3.89%, 16.46%, 71.40%, respectively. The rates of DR-TB, mono-resistant (MR)-TB, multidrug resistant (MDR)-TB, polydrug resistant (PDR)-TB in G1, G2, G3 and G0 were 19.24%/16.4%/17.33%/19.08%, 11.52%/8.68%/10.94%/11.63%, 3.03%/2.57%/2.96%/3.66%, 4.7%/4.82%/3.34%/4.08%, respectively. G3 had a higher risk of MDR1: isoniazid+rifampin (adjusted odds ratio (aOR)=1.913, 95% confidence interval(CI): 1.036-3.532), but had a lower risk of DR-TB (aOR=0.839, 95%CI: 0.712-0.988), rifampin-related resistance (aOR=0.675, 95%CI: 0.492-0.925), streptomycin-related resistance (aOR=0.819, 95%CI: 0.675-0.993), EMB-related resistance (aOR=0.571, 95%CI: 0.342-0.954), MDR3: isoniazid+rifampin+streptomycin (aOR=0.406, 95%CI: 0.194-0.851, any isoniazid+streptomycin resistance (aOR=0.845, 95%CI: 0.714-1). However, there were no significant differences between G1 and G0, G2 and G0 in all drug-resistant sub-types. Those who with cavity had a higher risk of DR-TB among G3 (OR=1.354, 95%CI:1.011-1.814).Conclusions: Although we did not found a independent impact of alcohol drinking or tobacco smoking on TB drug-resistance respectively, these two habits had a joint effect on TB drug-resistance. We should be alert for the emergence of isoniazid+rifampin resistance among populations with both smoking and drinking habits.
Background: With an aging population, China is facing a huge buedern of elderly patients with drug resistant tuberculosisi (DR-TB), which has become an significant obscale for the global TB control targets. There is still few study on DR-TB among China so far.Thus, more researches on the epidemiological characteristics and trend of primary DR-TB among the elderly will be necessary. Methods: A retrospective study was conducted in Shandong, China from 2004-2019, 12661 primary TB and 4368 elderly (≥60 years of age) primary TB cases were involved. Clinical characteristics including age, sex, Cavity, Smoking, drinking, comorbidity and drug susceptibility data were included. Descriptive statistical analysis, Chi-square and linear regression were used for analyzing.Results: Among 4368 elderly patients with primary TB, the DR-TB and MDR-TB accounted for 17.19% and 2.29% respectively. During 2004 to 2019, the proportions of MDR-TB, PDR-TB, RFP-resistance increased by160.00%, 18.18%, 231.82%, and the rate of DR-TB among elderly patients with primary cavitary TB increased by 255%.Among the elderly with primary DR-TB, the proportion of male (from 85.19 to 89.06), cavity (from 7.41 to 46.88), RFP (from 3.70 to 21.88), SM (from 37.04 to 62.5) increased significantly(P<0.05) . And the proportion of female (from 14.81 to 10.94), non-cavity (from 92.59 to 32.81 ), INH (from 66.67 to 57.81 ) decreased significantly. (P<0.05) .Conclusion: Among the elderly, the proportions of MDR-TB, PDR-TB,RFP-resistance and cavitary DR-TB increased significantly. The pattern of DR-TB changed from female, non-cavity and INH-resistant groups to male, cavity and RFP, SM-resistant groups. In order to a better control on the elderly DR-TB in the future, we should pay more attention to, male, smoking, drinking, COPD and diabetes subgroups.
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