Analysis On Prevalence Of Pulmonary Tuberculosis And Influence Factors Of Drug-resistance In Nanjing,2011-2015

Objectives1.To analyze the epidemiological characteristics of pulmonary tuberculosis(TB)inNanjing,so as to provide evidence for TB prevention and control.2.To describe the prevalence and risk factors for drug-resistant tuberculosis(DR-TB)and multidrug-resistant tuberculosis(MDR-TB)inNanjing,so as to provide theoretical support for drug-resistant TB prevention and control strategies.Methods1.Retrospectively collectedinformation of TB cases diagnosed in Nanjing fixed-point TB hospital during January 2011 to December 2015,andanalyzed TB epidemic situation and epidemiological characteristic with the descriptive research method.2.Mycobacterium culture and drug susceptibility test(DST)were completed for 995high-riskDR-TB patients registered from April 2012 to December 2015,then retrospectively collected results of drug susceptibility to isoniazid,rifampicin,ofloxacin and kanamycin.Analyses were conducted with SPSS 19.0.Patients with non-drug resistant was used as control to identify influence factors associated with drug-resistant tuberculosis(DR-TB)and multidrug-resistant tuberculosis(MDR-TB).Results1.From 2011 to 2015,13516 TB patients were reported,the average annual incidence was 33.44/10~5.The incidence of pulmonary tuberculosis was slowly decreasing in 5 years.The temporal distribution indicated that the largest number of patients was reported in April and May which totallyaccounted for 19.34%,and the next was in September which separately accounted for 9.22%.The incidence of male(44.41/10~5)was higher than that of female(21.68/10~5).The patients between 55 to 64 years old has the largest number and accounted for17.98%.The farmer accounted for the most part of the occupation distribution(26.01%),and the next was retirees and worker which separately accounted for 17.45%and 12.50%.The incidence between the districs was not balanced,the highest(standardized rate)was in Gaochun District(60.87/10~5).The 4 urban areas has the lowest incidence,followed by suburbs aroud 4 urban areas and the highest in rural areas.In addition,the incidence rate in the 4 urban areas decreased year by year,while that of the suburbs aroud 4 urban areas increased.2.The overall drug-resistance rate was 40.00%,36.79%in new TB patients and 45.24%in re-treated patients,there was significant difference(χ~2=6.97,P<0.05).The overall multidrug-resistance rate was 17.48%,12.97%in new TB patients and 24.97%in re-treated patients,there was significant difference(χ~2=23.01,P<0.05).The resistant rate to rifampicin was highest,followed by isoniazid,ofloxacinand kanamycin.MDR-TB patients accounted for 43.72%of drug-resistant TB patients,XDR-TB patients accounted for 13.79%ofMDR-TB patients.Multiple logistic regressions showed that age and treatment history was significantly associated with DR and MDR.Compared with the elderly over 80,people between 30-59 had higher risk for DR(30-39 years:OR=2.124,95%CI:1.167-3.867;40-49 years:OR=1.742,95%CI:1.018-2.980;50-59 years:OR=2.230,95%CI:1.360-3.658),and MDR(30-39years:OR=4.905,95%CI:2.107-11.418;40-49years:OR=2.696,95%CI:1.190-6.108;50-59 years:OR=4.248,95%CI:2.001-9.019).Comparedwiththenewcases,previously treated ones had higher risk for DR(OR=1.400,95%CI:1.071-1.828)and MDR(OR=2.361,95%CI:1.649-3.380).Conclusions1.The incidence of TB in Nanjing is steady declined in recent years.However,the incidence of TB is different in time,populations and areas,so pertinence measures should be strengthened to prevent and control TB according to the epidemiological characteristics.2.The high prevalence of drug resistance has been a big challenge for TB control In Nanjing.Measures should be taken to reduce the generation and spread of drug-resistant TB.Molecular detection method should be promoted as soon as possible to find drug-resistant TB patients in time and therapy earlier.Strengthen the management of confirmed drug-resistant TB patients to promote the curative rate.Emphasis should be placed on strengthening the supervision management and health education of patients aged 30-59 and re-treated patients so as to improve treatment compliance.Drug resistance detection is necessary for re-treated patients;a reasonable chemotherapy regimen according to the results of DST could effectively prevent the occurrence of drug resistance.