Determining Mycobacterium tuberculosis Drug Resistance and Risk Factors for Multidrug-Resistant Tuberculosis in Sputum Smear-Positive Tuberculosis Outpatients in Anhui Province, China, 2015–2016

Figures & data

Figure 1 Specific steps for sampling.

Figure 2 Layout of the county (district) administrative divisions covered by 40 survey sites.

Table 1 Drug Resistance to First-Line and Second-Line Anti-Tuberculosis Drugs in Anhui, China, 2015–2016

Resistance Profile	All SSPTBPs n=2530		New Cases n=2133		Previously Treated Cases n=397
	n	% (95% CI)	n	% (95% CI)	n	% (95% CI)
Any TB Drug Resistance
Isoniazid	337	13.32(11.94–14.82)	223	10.45(9.13–11.92)	114	28.72(23.69–34.50)
Rifampin	289	11.42(10.14–12.82)	163	7.64(6.51–8.91)	126	31.74(26.44–37.79)
Streptomycin	321	12.69(11.34–14.15)	234	10.97(9.61–12.47)	87	21.91(17.55–27.03)
Ethambutol	74	2.93(2.30–3.67)	40	1.88(1.34–2.55)	34	8.56(5.93–11.97)
Ofloxacin	225	8.89(7.77–10.13)	139	6.52(5.48–7.69)	86	21.66(17.33–26.75)
Kanamycin	41	1.62(1.16–2.20)	30	1.41(0.95–2.00)	11	2.77(1.38–4.96)
Poly-resistance^a	314	12.41(11.08–13.86)	191	8.96(7.73–10.32)	123	30.98(25.75–36.97)
MDR	193	7.63(6.59–8.66)	106	4.97(4.05–5.89)	87	21.91(17.83–26.00)
XDR	23	0.91(0.57–1.36)	13	0.61(0.32–1.04)	10	2.52(1.21–4.63)

Note: ^aPoly-resistance: resistance to two or more drugs excluding resistance to both isoniazid and rifampin.

Abbreviations: MDR, resistance to isoniazid and rifampin; XDR, resistance to at least isoniazid, rifampin, ofloxacin, and kanamycin; TB, tuberculosis; MDR, multidrug-resistant; XDR, extensively drug-resistant; SSPTBPs, sputum smear-positive tuberculosis patients.

Table 2 Analysis of Risk Factors for Multidrug-Resistant Tuberculosis (MDR-TB) in All Cases

Variables	All SSPTBPs				Univariate Analysis		Multivariate Analysis
	Non-MDR	MDR	n	%	Odds Ratio (OR) (95% CI)	p-value	Adjusted OR(95% CI)	p-value
Sex			2529			0.412
Male	1813	144	1957	7.36	1
Female	524	48	572	8.39	1.153(0.820–1.622)	0.412
Age						0.138
0~	70	7	77	9.09	1
20~	570	42	612	6.86	0.726(0.314–1.679)	0.455
40~	649	78	727	10.73	1.185(0.526–2.669)	0.683
60~	1038	65	1103	5.89	0.611(0.270–1.384)	0.238
Educational status						0.303
Illiterate	671	42	713	5.89	1
Primary school	590	49	639	7.67	1.327(0.866–2.033)	0.194
Middle school	656	70	726	9.64	1.705(1.146–2.537)	0.009
Senior high school	265	23	288	7.99	1.387(0.818–2.351)	0.225
University	154	8	162	4.94	0.830(0.382–1.803)	0.638
Family income in 2014						0.362
<2500	254	19	273	6.96	1
2500–4200	328	26	354	7.34	1.06(0.574–1.958)	0.853
4201–20,000	729	66	795	8.30	1.210(0.712–2.056)	0.48
20,001–50,000	630	60	690	8.70	1.271(0.744–2.173)	0.38
>50,000	222	11	233	4.72	0.655(0.310–1.429)	0.665
Household contact with TB patients						0.005
No	2175	168	2343	7.17	1
Yes	162	24	186	12.90	1.918(1.215–3.028)	0.005
Past anti-TB treatment courses						<0.001
No	2006	103	2109	4.88	1
Yes	331	89	420	21.19	5.237(3.854–7.115)	<0.001
The number of anti-TB treatment courses						<0.001		0.004
1	252	33	285	11.58	1		1
2	42	24	66	36.36	4.071(2.202–7.528)	<0.001	5.367(1.258–22.897)	0.023
≥3	40	29	69	42.03	5.089(2.826–9.163)	<0.001	13.143(3.487–49.534)	0.001
Adverse drug reaction						0.573
No	235	58	293	19.80	1
Yes	98	28	126	22.22	1.179(0.713–1.949)	0.522
Duration of the first anti-TB treatment courses						0.009
6–8 months	163	40	203	19.70	1
<6 months	140	28	168	16.67	0.822(0.487–1.388)	0.463
>8 months	27	17	44	38.64	2.720(1.341–5.515)	0.006
Discontinuation of previous anti-TB treatment courses						0.092
No	197	42	239	17.57	1
Yes	134	43	177	24.29	1.504(0.936–2.417)	0.091
Number of discontinuation of previous anti-TB treatment courses						0.008
1	83	15	98	15.31	1
2	19	9	28	32.14	2.429(0.935–6.308)	0.068
≥3	32	19	51	37.25	3.238(1.489–7.040)	0.003

Table 3 Analysis of Risk Factors for Multidrug-Resistant Tuberculosis (MDR-TB) in New Cases

Variables	New Cases				Univariate Analysis
	Non-MDR	MDR	n	%	Odds Ratio (OR) (95% CI)	p-value
Sex						0.58
Male	1550	77	1627	4.73	1
Female	478	27	505	5.35	1.137(0.725–1.784)	0.576
Age						0.126
0~	69	7	76	9.21	1
20~	527	27	554	4.87	0.505(0.212–1.203)	0.123
40~	543	34	577	5.89	0.617(0.263–1.446)	0.267
60~	888	36	924	3.90	0.4(0.172–0.931)	0.034
Educational status						0.181
Illiterate	581	23	604	3.81	1
Primary school	496	21	517	4.06	1.070(0.585–1.956)	0.827
Middle school	570	40	610	6.56	1.773(1.048–2.999)	0.033
Senior high school	237	14	251	5.58	1.492(0.755–2.949)	0.25
University	143	6	149	4.03	1.060(0.424–2.651)	0.901
Family income in 2014						0.692
<2500	210	11	221	4.98	1
2500–4200	283	19	302	6.29	1.282(0.597–2.751)	0.524
4201–20,000	633	32	665	4.81	0.965(0.478–1.949)	0.921
20,001–50,000	554	30	584	5.14	1.034(0.509–2.100)	0.927
>50,000	197	7	204	3.43	0.678(0.258–1.785)	0.432
Household contact with TB patients						0.41
No	1896	95	1991	4.77	1
Yes	132	9	141	6.38	1.361(0.672–2.757)	0.392

Table 4 Analysis of Risk Factors for Multidrug-Resistant Tuberculosis (MDR-TB) in Previously Treated Cases

Variables	Previously Treated Cases				Univariate Analysis		Multivariate Analysis
	Non-MDR	MDR	n	%	Odds ratio (OR) (95% CI)	p-value	Adjusted OR Values	Adjusted p-value
Sex						0.056
Male	263	67	330	20.30	1
Female	46	21	67	31.34	1.785(0.998–3.194)	0.051
Age						0.008
20~	43	15	58	25.86	1
40~	106	44	150	29.33	1.190(0.600–2.360)	0.619
60~	160	29	189	15.43	0.523(0.257–1.062)	0.073
Educational status						0.595
Illiterate	90	19	109	17.43	1
Primary school	94	28	122	22.95	1.395(0.728–2.675)	0.316
Middle school	86	30	116	25.86	1.634(0.856–3.119)	0.137
Senior high school	28	9	37	24.32	1.506(0.612–3.702)	0.373
University	11	2	13	15.38	0.852(0.174–4.160)	0.843
Family income in 2014						0.077
<2500	44	8	52	15.38	1
2500–4200	45	7	52	13.46	0.856(0.286–2.560)	0.78
4201–20,000	95	34	130	26.15	1.968(0.842–4.601)	0.118
20,001–50,000	77	30	107	28.30	2.143(0.904–5.081)	0.084
>50,000	24	4	28	14.29	0.917(0.250–3.361)	0.896
Household contact with TB patients						0.071
No	278	73	351	20.80	1
Yes	30	15	45	33.33	1.890(0.966–3.699)	0.141
Past anti-TB treatment courses
No	0	0	0
Yes	303	88	391	22.51
The number of anti-TB treatment courses						<0.001		0.002
1	221	33	254	12.99	1		1
2	42	24	66	36.36	3.827(2.057–7.119)	<0.001	4.544(1.054–19.590)	0.042
≥3	40	29	69	42.03	4.855(2.660–8.864)	<0.001	11.100(2.913–42.300)	<0.001
Adverse drug reaction						0.584
No	213	58	271	21.40	1
Yes	89	28	117	23.93	1.155(0.691–1.933)	0.582
Duration of the first anti-TB treatment courses						0.023
6–8 months	160	40	200	20	1
<6 months	115	28	143	19.58	0.889(0.517–1.527)	0.669
>8 months	25	17	42	40.48	2.482(1.222–5.041)	0.012
Discontinuation of previous anti-TB treatment courses						0.038
No	187	42	229	18.34	1
Yes	114	43	157	27.39	1.665(1.026–2.703)	0.039
Number of discontinuation of previous anti-TB treatment courses						0.053
1	67	15	82	18.29	1
2	20	9	29	31.03	2.010(0.765–5.279)	0.156
≥3	33	19	52	36.54	2.572(1.161–5.695)	0.02