| Objective This study aimed to provide scientific basis for the prevention and control of tuberculosis in Hainan Province,China.In order to achieve this goal,this study investigated the changes of drug resistance rate of Mycobacterium tuberculosis(M.tuberculosis)in Hainan Province from 2014 to 2019,and this study investigated factors influencing multidrug-resistant M.tuberculosis,in addition,this study also investigated the genetic characteristics of M.tuberculosis.Methods From January 1,2014 to December 31,2019,those who were cultured-positive of Mycobacterium,confirmed as M.tuberculosis by Mycobacterium species identification testing and had undergone drug susceptibility testing of M.tuberculosis in the Provincial Clinical Center on Tuberculosis of Hainan were included in this study.Data of laboratorial and clinical information were collected retrospectively.The count data were compared byX~2 test or fisher exact probability method,the measurement data were compared by t test or nonparametric test,and the factors influencing multidrug-resistant M.tuberculosis were investigated by conditional logistic regression.Results In the past 6 years,for all cases,the drug resistance rate and multidrug resistance rate of M.tuberculosis were 44.3%and 24.9%,respectively.Drug resistance rates of isoniazid,ethambutol and ofloxacin showed decreasing trend(P<0.05),but drug resistance rates of rifampicin,kanamycin and protionamide showed increasing trend(P<0.05).Drug resistance rates in newly treated cases have no significant changes(P>0.05),but in retreated cases,the resistance rates of rifampicin increased at an annual rate of 0.05%per year(X~2=14.257,P=0.014),and the resistance rate of protionamide increased at the rate of 0.44%per year(X~2=35.332,P<0.001).This study found that the possibility of multidrug resistance rate of those with diabetes were 2.854 times higher than those without diabetes(P=0.011)in newly treated cases,while those with"4+"culture was 3.121 times higher than those with"<1+"culture(P=0.003),and those with lung cavity were 2.372 times higher than those without lung cavity(P=0.004)in retreated cases.Isoniazid resistance gene mutations of M.tuberculosis were katG gene mutations(70.8%(204/288))>inhA gene mutations(8.0%(23/288))>katG gene and inhA gene combined mutations(1.0%(3/288)).Rifampicin resistant gene mutations of M.tuberculosis were rpoB531(43.6%(167/383))>rpoB526(18.3%(70/383))>rpoB511(7.0%(27/383))>rpoB516(5.5%(21/383))>rpoB533(2.1%(8/383))>rpoB513(1.6%(6/383)).Multidrug resistant gene mutations of M.tuberculosis were rpoB+katG(71.1%(172/242))>rpoB+inhA(3.3%(8/242))>rpoB+rpoB+katG(3.3%(8/242))>rpoB+katG+inhA(1.2%(3/242)).Conclusions The drug resistance rate of M.tuberculosis in Hainan Province is high.Except streptomycin and capreomycin,the drug resistance rates of other tested drugs have changed significantly.Among tuberculosis patients,patients with diabetes mellitus,patients with a culture result of"4+",patients with lung cavity have a higher multidrug resistance rate,monitoring the drug resistance of these patients is helpful to reduce the burden of drug resistance.The most common mutations of isoniazid resistant,rifampicin resistant and multidrug-resistant Mycobacterium tuberculosis were katG gene mutation,rpoB531 gene mutation and rpoB+katG gene mutation,respectively. |
PDF Full Text Request