Prevalence of tuberculosis drug resistance in 10 provinces of China

Guang Xue He, Yan Lin Zhao, Guang Lu Jiang, Yu Hong Liu, Hui Xia, Sheng Fen Wang, Li Xia Wang, Martien W Borgdorff, Marieke J van der Werf, Susan van den Hof, Guang Xue He, Yan Lin Zhao, Guang Lu Jiang, Yu Hong Liu, Hui Xia, Sheng Fen Wang, Li Xia Wang, Martien W Borgdorff, Marieke J van der Werf, Susan van den Hof

Abstract

Background: The emergence of drug-resistant tuberculosis (TB) hampers TB control. Ten provinces in China performed drug resistance surveys among tuberculosis (TB) patients in 1996-2004 to assess levels of drug resistance.

Methods: Provincial drug resistance surveys included all isolates from newly diagnosed, smear-positive TB patients. Drug susceptibility testing (DST) against isoniazid, rifampicin, streptomycin and ethambutol was carried out in the provincial laboratories. For purposes of quality assurance, a random sample (11.6%) was re-tested by the national reference laboratory (NRL).

Results: Of 14,059 patients tested 11,052 (79%) were new TB cases. The weighted mean prevalence of multi-drug resistant tuberculosis (MDR-TB) among all cases was 9.3% (range 2.2%-10.4%); 5.4% (range 2.1% - 10.4%) among new cases and 25.6% (range 11.7%-36.9%) among previously treated cases. Adjusting the drug resistance proportions using the re-testing results did not change the estimated national mean prevalence significantly. However, in some individual provinces the estimated resistance proportions were greatly influenced, especially among re-treatment patients.

Conclusion: MDR-TB levels varied greatly between provinces in China, but on average were high compared to the global estimated average of 4.8%. This study shows the importance of quality-assured laboratory performance. Programmatic management of drug-resistant TB, including high quality DST for patients at high risk of resistance and treatment with second-line drugs, should become the standard, especially in high MDR-TB settings.

Figures

Figure 1
Figure 1
MDR-TB proportions among new and previously treated cases observed in the provincial drug resistance surveys.
Figure 2
Figure 2
Re-testing results by the national reference laboratory on a random selection of the isolates as tested by the provincial laboratories. Concordance between provincial laboratories and the national reference laboratory for isolates tested resistant by the provincial laboratory is shown by light bars, for isolates tested susceptible by dark bars. The adjustment ratio (•) indicates the amount of over- or underestimation of resistance by the provincial laboratory (ratio above unity indicates overestimation).

References

    1. World Health Organization . Report no 4 WHO/HTM/TB/2008394. Geneva, Switzerland: World Health Organization; 2008. Anti-tuberculosis drug resistance in the world.
    1. World Health Organization . WHO report 6007 WHO/HTM/TB/2006361. Geneva, Switzerland: World Health Organization; 2006. Guidelines for the programmatic management of drug-resistant tuberculosis.
    1. CDC Revised definition of extensively drug-resistant tuberculosis. MMWR. 2006;55:1176.
    1. Shah NS, Wright A, Bai GH, et al. Worldwide emergence of extensively drug-resistant tuberculosis. Emerg Infect Dis. 2007;13:380–7.
    1. World Health Organization . WHO report 2007 WHO/HTM/TB/200789. Geneva, Switzerland: World Health Organization; 2007. Global tuberculosis control: surveillance, planning, financing.
    1. National Technical Steering Group of the Epidemioligical Sampling Survey for Tuberculosis Report on nationwide random survey for the epidemiology of tuberculosis in 2000. The Journal of the Chinese Antituberculosis Association. 2000;24:65–108.
    1. Zignol M, Hosseini MS, Wright A, et al. Global incidence of multidrug-resistant tuberculosis. J Infect Dis. 2006;194:479–85. doi: 10.1086/505877.
    1. World Health Organization . Report no 3 WHO/HTM/TB/2004343. Geneva, Switzerland: World Health Organization; 2004. Anti-tuberculosis drug resistance in the world.
    1. Li Q, Wang X, He H, et al. Report on Zhejiang provincial TB drug resistant survey. Chinese Journal of Tuberculosis and Respiratory Disease. 2000;23:718–21.
    1. Zhong Q, Qian M, Li J, et al. Report on Guangdong provincial TB drug resistant survey. The Journal of the Chinese Antituberculosis Association. 2001;23:5–8.
    1. Wang G, Peng Y, Zhang G, et al. Report on Henan provincial TB drug resistant survey. The Journal of the Chinese Antituberculosis Association. 1999;21:167–8.
    1. Wang G, Peng Y, Zhang G, et al. Report on Henan provincial TB drug resistant survey. The Journal of the Chinese Antituberculosis Association. 1999;21:185–190.
    1. Wang S, Zhang F, Duanmu H. The situation of tuberculosis drug resistance in Shandong province. Chinese Journal of Tuberculosis and Respiratory Disease. 1999;22:728–30.
    1. Mei J, Shen X, Shen M, et al. Survey of drug-resistant M. Tuberculosis in Shanghai, China. The Journal of the Chinese Antituberculosis Association. 2007;29:395–8.
    1. An Y, Ding B, Zhu J, et al. Report of WHO survey on drug-resistant tuberculosis in Beijing. The Journal of the Chinese Antituberculosis Association. 2007;29:475–8.
    1. World Health Organization . WHO/TB/96216. Geneva, Switzerland: World Health Organization; 1997. Guidelines for surveillance of drug resistance in tuberculosis.
    1. Wang G, Peng LY , Zhang ZG , et al. Sample survey of drug-resistant tuberculosis in Henan, China, 1996. Respirology. 2002;7:67–72. doi: 10.1046/j.1440-1843.2002.00368.x.
    1. Bonnet M, Siziaire V, Kebede Y, et al. Does one size fit all? Drug resistance and standard treatments: results of six tuberculosis programmes in former Soviet countries. Int J Tuberc Lung Dis. 2005;9:1147–54.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi