Infection and Drug Resistance (Oct 2021)
Predictors and Trends of MDR/RR-TB in Shenzhen China: A Retrospective 2012–2020 Period Analysis
Abstract
Ji Lecai,1,2,* Peierdun Mijiti,3,* Hong Chuangyue,2 Li Mingzhen,2 Gao Qian,3 Tan Weiguo,2 Chen Jihong1 1Department of Nephrology, Affiliated Bao’an Hospital of Shenzhen, The Second School of Clinical Medicine, Southern Medical University, Shenzhen, Guangdong, 518101, People’s Republic of China; 2Department of Tuberculosis, Shenzhen Center for Chronic Disease Control, Shenzhen, 518000, Guangdong, People’s Republic of China; 3The Key Laboratory of Medical Molecular Virology of Ministries of Education and Health, School of Basic Medical Science, Fudan University, Shanghai, 200032, People’s Republic of China*These authors contributed equally to this workCorrespondence: Chen JihongDepartment of Nephrology, Affiliated Bao’an Hospital of Shenzhen, No. 2 Longjing Road, Xinglong Street, Shenzhen, Guangdong, 518101, People’s Republic of ChinaTel/Fax +86-755-2778-8311Email [email protected] QianKey Laboratory of Medical Molecular Virology, School of Basic Medical Sciences, Fudan University, Dongan Road No. 131, Shanghai, 200032, People’s Republic of ChinaTel/Fax +86-21-54237195Email [email protected]: We analyzed the trends and predictors of multidrug-resistant (MDR) or rifampicin-resistant (RR) tuberculosis (TB) in culture-positive cases in Shenzhen during 2012– 2020, after the implementation of improved strategies (scale-up molecular drug susceptibility testing [mDST], expansion of DST eligibility, and generous reimbursement of MDR-TB outpatient care costs).Materials and Methods: We retrospectively extracted and analyzed data from the TB Information System on drug-resistant pulmonary tuberculosis diagnosed in Shenzhen during the 2012– 2020 period. We analyzed trends in RR- and MDR-TB rates in new cases during 2012– 2018 and 2018– 2020 periods, and among previously-treated cases during 2012– 2017 and 2017– 2020 periods, using Cochran-Armitage tests. We generated multivariate logistic regression models to analyze demographic predictors of MDR/RR-TB rates.Results: We found 21,367 positive mycobacterial cultures in Shenzhen during the 2012– 2020 period, and 19,951 (93.4%) were identified as Mycobacterium tuberculosis and had DST results (92.0% of those were mDST-based). Of these patients with DST results, 1630 (8.2%) were RR-TB, and 1142 (5.7%) were MDR-TB. Of the RR-TB, 70% were MDR-TB. The MDR/RR-TB rate in new TB cases increased significantly during the 2012– 2018 period (Ptrend 0.05, with a significant trend for MDR-TB). Among previously treated cases, the temporal MDR/RR-TB rate trends did not differ significantly (Ptrend > 0.05). Our multivariate analysis showed that age younger than 30 years, housework service/unemployment, local residency, and previous TB treatment were all predictors of MDR/RR-TB. The percentage of patients with MDR-TB on treatment increased from 49.4% in 2012 to 70.5% in 2020. The treatment success rate of patients with MDR-TB during the 2012– 2018 period was 71%.Conclusion: During the study period in Shenzhen, the cases of MDR/RR-TB were detected, and the treatment enrollment increased and the MDR-TB rates decreased gradually after 2017. Decreasing trends may reflect the efficacy of improved strategies; however, their long-term impact on the MDR-TB burden remains to be investigated. The predictors of MDR-TB identified in our study should be considered when developing targeted MDR-TB control strategies.Keywords: MDR/RR-TB, trend, predictors, Shenzhen, 2012– 2020
