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Abstract
Purpose
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), but it decreased in the 2018–2020 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.
Acknowledgments
We express our thanks and appreciation to all of the staff involved in data recording and data management in the Shenzhen CCDC. Special thanks to Prof. Howard Takiff for the critical review and English language editing of this manuscript.
Abbreviations
TB, tuberculosis; DST, drug sensitivity testing; mDST, molecular drug sensitivity testing; INH, isoniazid; RMP, rifampicin; MDR-TB, multidrug-resistant TB; MDR/RR-TB multidrug-resistant TB or rifampicin resistant TB; MTB, Mycobacterium tuberculosis; CCDC, center for chronic disease control; aOR, adjusted odds ratios.
Data Sharing Statement
The dataset used to support the findings of this study will be made available by the corresponding author upon reasonable request.
Ethical Approval and Informed Consent
The Ethics Committee of Shenzhen Center for Chronic Disease Control approved this study (Approval number: SZCCC-2020-021-01-YJ). We ensured the confidentiality of patient data and complied with the Helsinki statement tenets. Due to the retrospective nature of the study, the Ethics Committee waived the requirement for patient consents.
Author Contributions
All authors made a significant contribution to the work reported during the conception, study design, execution, data acquisition, analysis, interpretation, drafting, and revising, or critically reviewing the article. All authors gave their final approval of the version to be published and the chosen journal for submission, and they agreed to be accountable for all aspects of the work.
Disclosure
The authors declare having no conflicts of interest in this work.