Prevalence And Associated Factors Of Drug Resistance-tuberculosis In Central Anhui Province

Objective:Toevaluatetheprevalenceandassociatedfactorsofdrug resistance-tuberculosis in central Anhui Province,and to improve the prevention and control of tuberculosis in central Anhui Province.Methods:In this study,the central Anhui Province was used as the research site,and stratified cluster sampling method was adopted to select 15 survey spots in Hefei,Anqing,Chuzhou and Lu’an.Including tuberculosis patients who were positive smear culture from September 1st,2015 to June 30th,2016.By collecting bacteriological data from tuberculosis patients,analyzing the drug resistance rates(monoresistance,polydrug resistance,multidrug resistance,etc)and drug resistance order,to obtain baseline information of drug resistance-tuberculosis in central Anhui Province.By collecting the general demographic characteristics,medical history,treatment history,to evaluate the influencing factors of drug resistance-tuberculosis.Results:1.Among 1083 tuberculosis patients,828 were males,accounting for 76.5%,the male-female ratio was 3.25:1.The age was between 8-90 years old with an average age of(53.62±19.55)years old.915(84.5%)were initial treatment patients,and168(15.5%)were retreatment patients.2.Among 1083 strains of Mycobacterium tuberculosis,282 were drug resistance Mycobacterium tuberculosis strains with a drug resistance rate of 26.0%.The drug resistance rate of initial treatment patients and retreatment patients were 21.1%(193/915)and 53.0%(89/168).There were 78 multidrug resistance Mycobacterium tuberculosis strains with a multidrug resistance rate of 7.2%.The multidrug resistance rate of initial treatment patients and retreatment patients were 3.8%(35/915)and 25.6%(43/168).3.The drug resistance order of 1083 Mycobacterium tuberculosis strains was INH,SM,RFP,Ofx,EMB,Km.The drug resistance order of initial treatment patients was SM,INH,Ofx,RFP,EMB,Km,and the drug resistance order of retreatment patients was INH,RFP,Ofx,SM,EMB,Km.4.Among the 282 strains of drug resistance Mycobacterium tuberculosis,there were144(13.3%)strains with single drug resistance.102(9.4%)strains resistant to two drugs,the highest drug resistance group was INH+SM;69(6.4%)strains resistant to three drugs,the highest drug resistance group was INH+RFP+SM;There were 46(4.2%)strains of Mycobacterium tuberculosis resistant to four or more drugs,31(2.9%)strains resistant to four drugs,13(1.2%)strains resistant to five drugs,and 2(0.2%)strains resistant to six drugs.5.There were statistically significant differences in drug resistance rates(resistant to two drugs,three drugs,four or more drugs)between the initial treatment patients,retreatment patients,and overall patients(?~2=565.90,P<0.001,?~2=374.64,P<0.001,?~2=245.58,P<0.001).6.The univariate,multivariate logistic analysis found that treated one time(OR=2.449,95%CI:1.612-3.723),treated twice or more(OR=8.517,95%CI:4.989-14.538)were risk factors of drug resistance-tuberculosis.Age less than 20 years old(OR=4.735,95%CI:1.448-15.480),40-60 years old(OR=1.985,95%CI:1.094-3.600),treated one time(OR=5.437,95%CI:2.805-10.539),treated twice or more(OR=28.968,95%CI:14.688-57.133)were risk factors of multidrug resistance-tuberculosis.Conclusion:The condition of drug resistance-tuberculosis in central Anhui Province is still severe.Isoniazid,rifampicin,streptomycin resistance are serious,the use of first-line anti-tuberculosis drugs should be standardized,and rational use of drugs.Retreatment is a risk factor for drug resistance in tuberculosis patients.For retreatment tuberculosis patients,supervision and management should be strengthened while standardizing treatment.With more treatment histories,middle-young age were risk factors for drug resistance.The treatment should be carried out in strict accordance with the guidelines and standard chemotherapy regimens,and patients should be supervised throughout the treatment to minimize the number of treatments and to reduce the risk of drug resistance.