Prevalence of Tuberculosis Drug Resistance in 10 Provinces of China

BMC Infect Dis. 2008 Dec 11;8:166. doi: 10.1186/1471-2334-8-166.

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.

MeSH terms

  • Antitubercular Agents / pharmacology*
  • China / epidemiology
  • Drug Resistance, Multiple, Bacterial
  • Ethambutol / pharmacology
  • Humans
  • Isoniazid / pharmacology
  • Microbial Sensitivity Tests
  • Mycobacterium tuberculosis / drug effects*
  • Mycobacterium tuberculosis / isolation & purification*
  • Prevalence
  • Reproducibility of Results
  • Rifampin / pharmacology
  • Sputum / microbiology
  • Streptomycin / pharmacology
  • Tuberculosis / epidemiology
  • Tuberculosis / microbiology
  • Tuberculosis, Multidrug-Resistant / epidemiology*
  • Tuberculosis, Multidrug-Resistant / microbiology
  • World Health Organization

Substances

  • Antitubercular Agents
  • Ethambutol
  • Isoniazid
  • Rifampin
  • Streptomycin