Infection and Drug Resistance (Mar 2022)
HIV-Negative Rifampicin Resistance/Multidrug-Resistant Extrapulmonary Tuberculosis in China from 2015 to 2019: A Clinical Retrospective Investigation Study from a National Tuberculosis Clinical Research Center
Abstract
Jun Ma,1,* Hongcheng Liu,2,* Jingjing Wang,3,* Wenting Li,1 Lin Fan,1 Wenwen Sun1 1Department of Tuberculosis and Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China; 2Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China; 3Department of Emergency, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China*These authors contributed equally to this workCorrespondence: Wenwen Sun; Lin Fan, Department of Tuberculosis and Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, People’s Republic of China, Email [email protected]; [email protected]: China is the region with a high global burden of rifampicin resistance/multidrug-resistant tuberculosis (RR/MDR-TB) and low HIV incidence. Our aim was to assess the clinical and demographic characteristics of RR/MDR-extrapulmonary tuberculosis (EPTB) from 2015 to 2019 to provide evidence for the prevention and control of the disease in high TB burden areas.Methods: We investigated the clinical and demographic data of all MDR/RR-EPTB cases in a TB specialized hospital from China and compared the cases with the MDR/RR-pulmonary tuberculosis (PTB) patients over the same period.Results: Of the RR/MDR-TB patients enrolled, 15.4 were EPTB. The most common anatomical site was pleural/chest wall (25.9%). Compared with RR/MDR-PTB, females were more likely to be susceptible to RR/MDR-EPTB (OR 1.65, 95% CI 1.52– 1.77); the risk of RR/MDR-EPTB for 25– 44 years group increased (OR 1.61, 95% CI 1.52– 1.77), and then decreased with the increasing age (OR 1.48, 95% CI 0.74– 1.69 for 44– 65 years group and OR 2.23, 95% CI 0.98– 2.71 for ≥ 65 years group); more likely to be newly diagnosed (p < 0.01) and less likely to to combine with diabetes (P < 0.01), more dependent on GeneXpert MTB/RIF (Xpert, 90.9%) for diagnosis, with significantly higher rates of pre-XDR/XDR and significantly lower favorable treatment outcomes (both p < 0.01).Conclusion: There are clinical and demographic differences between RR/MDR-PTB and RR/MDR-PTB. Xper should be recommended at an early stage for suspected patients, and fluoroquinolones should be used cautiously for anti-infective therapy in this population.Graphical Abstract: Keywords: rifampicin resistance, multidrug resistant, extrapulmonary tuberculosis, clinical characteristics, Xpert MTB/RIF, fluoroquinolones
