Multidrug-Resistant Tuberculosis, People’s Republic of China, 2007–2009

He, Guo; Wang, Hai Ying; Borgdorff, Martien W.; Soolingen, Dick van; Werf, Marieke J. van der; Liu, Zhi Min; Li, Xue Zheng; Guo, Hui; Zhao, Yan; Varma, Jay K.; Tostado, Chris P.; Hof, Susan van den

doi:10.3201/eid1710.110546

Cited by 34 publications

(30 citation statements)

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“…Therefore, it can be expected that the 15-loci MIRU-VNTR technique may be a highly discriminatory tool for differentiating between clinical strains isolated from the region. However, the ETR-C locus showed very low diversity ( h = 0.02) in this study, which is in agreement with several studies from other areas of China [4,7,38,39]. In contrast, ETR-C showed high discriminatory power in a study from Spain ( h = 0.63) [5] and in another study from France ( h = 0.71) [6].…”

Section: Discussionsupporting

confidence: 90%

“…First, our results likely overestimated the percentage of drug resistance compared with population-based studies because a greater proportion of seriously ill TB cases may be included in a hospital-based study. In contrast, the clustering rate of drug-resistant TB was likely underestimated in our one-year molecular epidemiologic survey because the clustering proportion depends on the completeness of sampling, where increasing sampling fractions will identify more clustering [39,41]. Second, twelve non-Beijing family isolates were categorised as “unknown” in the present study using a similarity search on the MIRU-VNTR plus website.…”

Section: Discussionmentioning

confidence: 99%

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Genotyping and clinical characteristics of multidrug and extensively drug-resistant tuberculosis in a tertiary care tuberculosis hospital in China

et al. 2013

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BackgroundThere is a lack of information on the clinical characteristics of multidrug-resistant (MDR) tuberculosis (TB) and extensively drug-resistant (XDR) TB in the Jiangxi Province of China; furthermore, data have not been reported on the utility of mycobacterial interspersed repetitive-unit-variable-number tandem-repeat (MIRU-VNTR) analyses in genotyping Mycobacterium tuberculosis strains isolated from this region. The aim of this study was to analyse the clinical features of patients with MDR and XDR TB from Jiangxi Province and to evaluate the discriminatory power of the 15-loci MIRU-VNTR method.MethodsA retrospective study was conducted on patients diagnosed with MDR and XDR TB at the Jiangxi Chest Hospital from July 2010 to June 2011. The RD105 deletion-targeted multiplex PCR (DTM-PCR) and the 15-loci MIRU-VNTR method were used to determine the genetic background of the identified MDR and XDR M. tuberculosis clinical isolates.ResultsOf 804 M. tuberculosis clinical isolates, 159 (159/804, 19.8%) of the isolates were identified as MDR with first-line drug susceptibility testing. Of the 123 available MDR isolates, 13 (13/123, 10.6%) were XDR. The RD105 deletion-targeted multiplex PCR method identified 85 (85/110, 77.3%) MDR and 12 (12/13, 92.3%) XDR isolates as the Beijing genotype. MIRU-VNTR cluster analysis demonstrated that 101 MDR and 13 XDR strains had unique genotype patterns; the remaining 9 MDR strains were in 4 clusters, namely 1 cluster with 3 strains and 3 clusters with 2 strains, resulting in a low clustering rate (4.06%). The Hunter-Gaston discriminatory index (HGDI) of the 15-loci MIRU-VNTR method was as high as 0.992. In addition, clinical surveys showed that 87 (87/110, 79.1%) MDR TB patients and 10 (10/13, 76.9%) XDR TB patients had been previously treated. Diabetes mellitus was the most common comorbidity in both MDR TB (16/110, 14.5%) and XDR TB (2/13, 15.4%) patients.ConclusionsBased on our preliminary data, the MDR and XDR M. tuberculosis clinical isolates identified at the Jiangxi Chest Hospital were genetically diverse and clustered at a low frequency. The 15-loci MIRU-VNTR method showed high discriminatory power and may be used as a first-line genotyping tool in investigating the molecular epidemiology of M. tuberculosis in Jiangxi, China. Decisive measures are urgently needed to effectively prevent and manage MDR and XDR tuberculosis in this province.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Genotyping and clinical characteristics of multidrug and extensively drug-resistant tuberculosis in a tertiary care tuberculosis hospital in China

et al. 2013

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“…The MDR/RR-TB notification rate of farmers was higher than the rate of all other occupations and increased to 4.11 cases per 100,000 population in 2017. Our study showed that the occupation of farmer was associated with MDR/RR-TB, and some studies in other regions of China also showed that farmer was a risk factor [21]. In Chongqing, farmer was a poor occupation.…”

Section: Discussionsupporting

confidence: 58%

Epidemiology of drug-resistant tuberculosis in Chongqing, China: a retrospective observational study from 2010 to 2017

et al. 2019

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24China is one of the top 30 countries with high multidrug-resistant tuberculosis 2 25 (MDR-TB) and rifampin-resistant tuberculosis (RR-TB) burden. Chongqing is a 26 southwest city of China with a large rural population. A retrospective observational 27 study has been performed based on routine tuberculosis (TB) surveillance data in 28 Chongqing from 2010 to 2017. The MDR/RR-TB notification rate increased from 29 0.03 cases per 100,000 population in 2010 to 2.09 cases per 100,000 population in 30 2017. The extensively drug-resistant TB (XDR-TB) notification rate has increased to 31 0.09 cases per 100,000 population in 2017. There was a decreasing detection gap 32 between the number of notified MDR/RR-TB cases and the estimate number of 33 MDR/RR-TB cases among all notified TB cases. The treatment success rate of 34 MDR/RR-TB was 50.66% in this period. The rate of MDR/RR-TB in new TB cases 35 was 6.23%, and this rate in previously treated TB cases was 32.7%. Despite the 36 progress achieved, the prevalence of MDR/RR-TB was still high facing challenges 37 including detection gaps, the regional disparity, and the high risk for MDR/RR-TB in 38 elderly people and farmers. Sustained government financing and policy support 39 should be guaranteed in the future.40 41 42 Drug-resistant tuberculosis (DR-TB) threatens global TB prevention and control.43 MDR-TB, defined as TB resistant to at least rifampin (RFP) and isoniazid (INH), has 44 longer treatment regimens and lower treatment success rate with supplies of less 45 effective and more toxic second-line drugs [1]. RR-TB, defined as TB resistant to at 46 least RFP, also requires a second-line regimen, and 83% of RR-TB cases have 3 47

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“…Although historically MDR-TB was thought to be predominantly created through treatment mismanagement, primary transmission has been identified as a large problem both in China and elsewhere (12)(13)(14). As person-to-person spread of drug resistance increases, identifying the efficacy of diagnostic tools in both new and previously treated cases may become more important.…”

Section: T Uberculosis (Tb) Is An Infectious Disease Caused By the Bamentioning

confidence: 99%

Diagnostic Value of GeneChip for Detection of Resistant Mycobacterium tuberculosis in Patients with Differing Treatment Histories

et al. 2015

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The increasing burden of drug-resistant tuberculosis (TB) poses an escalating threat to national TB control programs. To assist appropriate treatment for TB patients, accurate and rapid detection of drug resistance is critical. The GeneChip test is a novel molecular tool for the diagnosis of TB drug resistance. Performance-related data on GeneChip are limited, and evaluation in new and previously treated TB cases has never been performed. We evaluated the diagnostic performance of GeneChip in detecting resistance to rifampin (RMP) and isoniazid (INH) and in detecting multidrug-resistant tuberculosis (MDR-TB) in comparison with standard drug susceptibility testing (DST) and compared the results in a group of previously treated and newly detected TB patients in an urban area in southeastern China. One thousand one hundred seventy-three (83.8%) new cases and 227 (16.2%) previously treated cases were collected between January 2011 and September 2013. The GeneChip showed a specificity of 97.8% and a sensitivity of 94.8% for detection of RMP resistance and 97.3% and 70.9%, respectively, for INH resistance in new cases. For previously treated cases, the overall sensitivity, specificity, and agreement rate are 94.6%, 91.3%, and 92.1%, respectively, for detection of RMP resistance and 69.7%, 95.4%, and 86.8%, respectively, for INH resistance. The sensitivity and specificity of MDR-TB were 81.8% and 99.0% in new cases and 77.8% and 93.4% in previously treated cases, respectively. The GeneChip system provides a simple, rapid, reliable, and accurate clinical assay for the detection of TB drug resistance, and it is a potentially important diagnostic tool in a high-prevalence area. T uberculosis (TB) is an infectious disease caused by the bacillusMycobacterium tuberculosis and remains a major global health problem. In 2012, the World Health Organization (WHO) estimated an incidence of 8.6 million new TB cases and 1.3 million TB deaths (just under 1.0 million among HIV-negative people and 0.3 million HIV-associated TB deaths) (1).The emergence of drug-resistant TB (especially multidrug-resistant TB [MDR-TB], defined as resistance to both rifampin [RMP] and isoniazid [INH]) represents a serious threat to TB control efforts worldwide. Globally, 3.6% of new TB cases and 20.2% of previously treated cases are estimated to have MDR-TB (1, 2). Acid-fast bacillus (AFB) smear microscopy is the most common method for diagnosing TB. However, low sensitivity and an inability to detect smear-negative pulmonary cases limit the usefulness of this technique (3, 4). Diagnosis based on culture is the reference standard, but results take weeks to obtain. Conventional drug susceptibility testing (DST) can provide definitive results, but this approach is time-consuming and usually requires several weeks to produce susceptibility profiles, which can lead to inadequate treatment and further acquired drug resistance during this period (5, 6). Therefore, highly sensitive and specific, easy-toapply, quick, and cost-effective methods are needed in the ...

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Multidrug-Resistant Tuberculosis, People’s Republic of China, 2007–2009

Abstract: Early detection, effective treatment, and infection control measures are needed to reduce transmission.

Cited by 34 publications

References 29 publications

Genotyping and clinical characteristics of multidrug and extensively drug-resistant tuberculosis in a tertiary care tuberculosis hospital in China

Genotyping and clinical characteristics of multidrug and extensively drug-resistant tuberculosis in a tertiary care tuberculosis hospital in China

Epidemiology of drug-resistant tuberculosis in Chongqing, China: a retrospective observational study from 2010 to 2017

Diagnostic Value of GeneChip for Detection of Resistant Mycobacterium tuberculosis in Patients with Differing Treatment Histories

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