A Case-control Study On Risk Factor For Acquired Drug Resistant Tuberculosis Of Adult

Objectives: To assess the status of drug resistance for acquired drug-resistant tuberculosis (ADR-TB) and explore the main risk factors of ADR-TB .To provide evidence for a reasonable drug selection in clinical use, disease effective prevention, intervention and control.Methods: A total cases of ADR-TB were selected from adult patients (positive for Mycobacterium tuberculosis in the culture) who sought for medical care in GuangXi LongTan hospital from 1st January, 2004 to 30th December, 2007. According to the laboratory science procedure of diagnostic bacteriology in tuberculosis, cultured Mycobacterium tuberculosis were used for testing drug susceptibility, and then follow-up investigations were conducted, 224 ADR-TB patients were involved in case group, 221 patients(negative for drug susceptibility test) were involved in control group. A questionnaire investigation about risk factors of ADR-TB was conducted,among them, the obtained data were analyzed by logistic regression and estimated with adjusted odds ratios (OR) and confidence interval (CI).Results:1. The ratio of mono-resistance tuberculosis was 38.84%, the ratio of multiple drug resistance tuberculosis was 40.63%, the frequency of drug resistance from high to low in order were isoniazide(73.21%),Rifampin(56.70%), Streptomycin(50.89%),ethambutol(19.64%),Ofloxacin(17.41%),Sodiumpara-am inosalicylate(12.95%),pyrazinamide(3.13%),protionamid(1.34%).2. The treatment of 207 out of the 445 patients was interrupted, The reasons of treatment interruption included giving up treatment when they feel better(41.06%), changing the medicine in the course of treatment(34.78%), side effect(13.04%), economic reason(7.73%), forgetting(1.45%) and other reasons(1.45%).3.The result of T text showed: the differences of age and course of disease between case group and control group is statistically significant (P<0.05). Analyzed by Fisher's exact probabilities in 2×2 table, the difference of AIDS exposure rate between case group and control group is statistically significant (P<0.05).4.The Logistic regression analysis use ADR-TB as dependent variable and 17 risk factors as independent variable, the results of single factor regression showed, 12 were selected: gender, age, dwelling place, educational level, treatment system, course of disease, treatment interruption, fluid population, smoking, monthly income per person, diabetes and retreatment(P<0.1). By multiple factors logistic regression analysis, eventually the factors enter the model are gender, age, dwelling place, educational level, treatment system, course of disease, treatment interruption, fluid population, smoking, diabetes and retreatment, the adjusted OR and CI were 2.721(1.078~5.226),2.034( 1.277~4.834 ), 2.746 ( 1.024~6.243 ), 2.389 ( 1.325~4.978 ), 4.003(3.089~8.114),6.001(3.047~8.635),39.641(20.366~51.369),2.968(1.677~4.486),1.758(1.067~3.374),8.964(5.365~18.971),and 35.874(21.569~55.786), respectively.Conclusions: The relevance of risk factors for ADR-TB from high to low were treatment interruption, retreatment, diabetes, long course of disease, treatment in the medical system, fluid population, living in countryside, male, low educational level, elder and smoking. Strengthening research on risk factors of ADR-TB and carrying out effective intervention measures are of great significance on reducing the incidence rate of ADR-TB.