Drug Resistance Characteristics of Mycobacterium tuberculosis Isolates From Patients With Tuberculosis to 12 Antituberculous Drugs in China

Abstract

Objective: To investigate the drug resistance characteristics of Mycobacterium tuberculosis (MTB) isolates from patients with tuberculosis to 12 antituberculous drugs in China.Methods: All clinical isolates of MTB were isolated from patients with tuberculosis in Shanghai Pulmonary Hospital (SPH) during the period from January 1st to December 31th, 2018. Drug susceptibility testing (DST) was performed in micro plates with 12 antituberculous drugs in accordance with relevant guideline. Demographic information, including sex, age, and treatment history was recorded.Results: A total of 1,950 MTB isolates were included in this retrospective study which were isolated from 1,950 patients from 29 regions in China. One thousand six hundred and forty-four were initial treated and 306 were re-treated in the hospital. Two hundred and eight (10.67%, 208/1,950) cases were diagnosed as multidrug-resistant tuberculosis (MDR-TB), from which 74 (4.50%, 74/1,644) cases were initial treated, and the remaining (43.79%, 134/306) were re-treated cases. Besides, the percentage of extensively drug-resistant tuberculosis (XDR-TB) varied in such 3 different groups: 1.64% (32/1,950) in total cases, 0.30% (5/1,644) in initial treated cases and 8.82% (27/306) in re-treated cases. The total resistance rates were as follows: isoniazid (361, 18.51%), streptomycin (302, 15.49%), rifampin (241, 12.36%), ofloxacin (239, 12.26%), moxifloxacin (232, 11.90%), rifabutin (195, 10.00%), ethambutol (100, 5.13%), cycloserine (55, 2.82%), kanamycin (48, 2.46%), ethionamide (40, 2.05%), amikacin (39, 2.00%), and aminosalicylic acid (21, 1.08%). Rates of resistance to any drug in re-treated cases were significantly higher than in initial treated cases. The drug resistance rates of the 12 drugs were higher in males than in females. Patients older than 60 years had significantly lower percentages of MDR/XDR-TB (7.11 and 0.65%) than in younger age groups. The proportion of re-treated cases in Shanghai (11.38%, 88/773) was lower than that in other regions. Meanwhile, the percentages of MDR/XDR-TB in Shanghai (4.79 and 0.65%) were significantly lower than in other regions.Conclusions: In this study, we found higher proportion of MDR/XDR-TB among re-treated cases than initial treated cases in China and the drug resistance rate of tuberculosis varied with age, sex, and region, indicating that standardized anti-tuberculosis treatment can reduce the incidence of drug-resistant tuberculosis and the recurrence of tuberculosis.

Prevalence of Antibiotic-Resistant Pulmonary Tuberculosis in Bangladesh: A Systematic Review and Meta-Analysis

“…However, a study in Hangzhou and another study in Shanghai, two cities in China, illustrated different prevalence of any isoniazid-resistance in retreatment cases: 29.0% and 53.2%, respectively. On the other hand any resistance to isoniazid in new patients (10.8%) was comparatively lower in Bangladesh than that in India, China, and Iran [ 13 , 35 , 36 , 37 , 38 ]. Any streptomycin-resistance was substantially high in Bangladesh among new (21.4%), retreatment (42.5%) and overall study subjects (29.2%).…”

“…Any rifampicin-resistance in retreatment patients was also markedly higher in Bangladesh (40.9%) than that reported in Pakistan (25.2%) and Iran (38.2%) but was lower than that of China (48.7%) and India (54.3%). Any ethambutol-resistance in retreatment patients was between 24% and 31% in several countries as compared to 27.6% in Bangladesh [ 13 , 35 , 36 , 39 ].…”

“…The prevalence of MDR-TB in both new (1.3%) and retreatment cases (20.9%) in Bangladesh was lower than that of India [ 12 ], Iran [ 13 ], Nigeria [ 14 ], China [ 15 , 35 ], and Pakistan [ 36 , 46 ]. However, the overall prevalence of MDR-TB (22.2%) is higher in Bangladesh than the rate of MDR-TB in above mentioned countries, except India.…”

“…In another study based in Pakistan, ofloxacin resistance was approximately three times higher (27.4%) in the previously treated cases although resistance to kanamycin was reported to be slightly lower (0.4%). Moreover, a high prevalence of kanamycin (6.5%) and ofloxacin (9.7%) resistance was reported in India [ 35 , 36 , 39 , 53 ]. A recent study illustrated that the fluoroquinolone resistance in MDR-TB patients was correlated with first-line anti-TB-DR and the genetic mutations in gyrA and gyrB genes [ 54 ].…”

Perfil epidemiológico de la tuberculosis extensivamente resistente en el Perú, 2013-2015

“…La TB-XDR es producida por bacterias resistentes a las drogas antituberculosas más efectivas, y se puede presentar un alto porcentaje de resistencia a las demás drogas de primera línea y a la mayoría de segunda línea, como se muestra en el presente reporte. Pocos estudios ( 4 , 10 , 17 , 23 ) han evaluado los diferentes patrones de resistencia de la TB-XDR y, más aún, su relación con el fracaso del tratamiento de TB resistente.…”