Epidemiological Characteristics And Influencing Factors Of Drug-Resistant Tuberculosis In Zhangjiakou Region

Objective:To investigate the drug-resistant TB prevalence and drug-resistant spectrum in zhangjiakou region,and to analyze the social demographic characteristics of drug-resistant TB patient population,clinical characteristics,history of treatment,regional distribution and migration of drug-resistant TB epidemic and the influence factors.Explore the influence factors of drug-resistant tuberculosis in the region,and provide reference materials for the local formulation of effective drug-resistant tuberculosis prevention and control measures.Methods:Random cluster sampling method was used in Zhangjiakou area 17 counties?districts?as the research site,in a population-based epidemiological studies of tuberculosis.Choose new registration of sputum mycobacterium tuberculosis culture positive tuberculosis patients between August 2018 to August 2019 as the research object,design a unified patient information questionnaire for the collection of basic data,and check the medical history records to obtain the selected other basic data and relevant epidemiological data;Thiophene p-nitrobenzoic acid-2-carboxylic acid hydrazine medium were used to identify whether the strains isolated from the sputum specimens of the research objects is Mycobacterium tuberculosis,and then isolate the clinical Strains carry out first-line anti-tb drugs[a total of four,including isoniazid?INH?,rifampicin?RFP?and ethambutol?EMB?and _including^streptomy _the^cin?SM?]_fluoroq ^and_{uinol one}^sec_?FLQ?^ond-lin _a^e _{n d}^a _kanam^{nti-tb drugs}_ycin?KM?^[a]^to _sen^{tal of}_{siti v} ^two_{ity t e st}^ki _to^nds,obtain drug-resistant spectrum.Strict quality control of the research process,statistical analysis and analysis of the data obtained using relevant statistical analysis software.Results:1. The prevalence of drug-resistant TB epidemic situation in Zhangjiakou regionDuring the study period,1028 strains of mycobacterium tuberculosis isolates into research,including the selection of six kinds of anti-tb drugs all sensitive strains for 837 strains?81.42%?,the above-mentioned six kinds of anti-tb drugs there was a resistant rate of 18.58%or above,and at the beginning of the resistant rate of 10.43%?81/776?,recurrent resistant rate44.05%?111/252?,recurrent rate higher than the initial percentages of ni??²=141.47,P=0.00?.All included in the study of mycobacterium tuberculosis prevalence of 6 kinds of anti-tb drugs resistance INH?11.96%?,OFX?2.63%?,SM?6.71%?,EMB?4.67%?,RFP?7.29%?,KM?0.49%?.Patients with recurrent isolates of 6 kinds of drug resistant rate were higher than patients treated first isolates?P<0.05?.Isolates were treated first and re-treat patients,the highest percentages of INH,7.47%and 25.79%,respectively.Included in the study of 1028 strains of mycobacterium tuberculosis isolates,only for a anti-tb drug resistant strain has 89 plants,single resistant rate of 8.66%.The initial single resistant rate was 7.35%?57/776?,recurrent single resistant rate was 12.70%?32/252?,the latter than the former??²=4.90,P=0.03?.More resistant rate was 3.70%?38/1028?,including initial more resistant rate 2.58%?20/776?,recurrent more resistant rate 7.14%?18/252?,which is high in the former??²=8.56,P=0.00?.MDR strains have 64 strains,MDR rate was 6.23%,including initial MDR of 17 cases,MDR cure rate was2.19%at the beginning of the retreatment MDR rate was 18.65%?47/252?,which is high in the former??²=39.36,P=0.00?.XDR strains have 5 strains,XDR rate was 0.49%?5/1028?.Drug-resistant TB in different gender??²=2.56,P=0.09?and age groups??²=6.44,P=0.12?,the differences in the distribution of patients have no statistical significance.41-60 years old age group MDR rate is higher than<20region??²=11.37,P=0.02?and the rate of MDR??²=14.19,P=0.01?were higher than under the dam area.2.Analysis of factors affecting drug-resistant tuberculosisThe results of single factor logistic regression model analysis showed that the analysis of the selected factors and the generation of initial drug resistance in patients with no statistical significance to the occurrence of drug resistance in newly treated patients.Gender,nationality,place of residence,treatment times,interruption of treatment duration,frequency and so on for the first time in six factors associated with recurrent patients with the development of drug resistance was statistically;Seven factors,include age,ethnic,cultural level,family income,residential areas,treatment times and interruption times,associated with the retreatment of patients with MDR was statistically.Multi-factor unconditioned logistic regression model analysis showed that:Male,multiple treatment and interruptions associated with recurrent patients resistant to produce a statistically?P<0.05?,low family economic income,multiple treatment and interruptions associated with the retreatment of patients with MDR was statistically?P<0.05?.Conclusion:1.The incidence of drug-resistant TB in Zhangjiakou was lower than the national level,but the incidence of MDR was higher than the national average,which indicates that the situation of drug-resistant TB in this region was severe.2. Compared with other first-line anti-TB drugs,the drug resistance level of SM in zhangjiakou was significantly lower than the domestic average level.The resistance rate of the second-line anti-TB drug OFX was low,but OFX resistance has a certain correlation with the first-line anti-TB drug resistance and MDR.3. The distribution of drug resistance was wide,and the drug resistance rate and the multi-drug resistance rate in the Bashang area were higher than those in the Baxia area;the multi-drug resistance rate in the 41-60 age group was higher than that in other age groups.In addition to geographical influences,the risk factors for drug-resistant tuberculosis include the number of floating population,the number of treatments,and the number of interruptions.The high incidence of drug-resistant tuberculosis in men may be related to poor compliance;the main risk factors for MDR-TB include family economic income and treatment times and interruptions.4. An important reason for the emergence of drug-resistant TB in Zhangjiakou may be the retreatment of drug resistance.