| Backgroud:Tuberculosis (TB) remains the major public health burden of the world. The proportion of TB cases that are caused by drug resistant strains is globally increasing, which poses a great challenge for TB control. Fluoroquinolones has been widely used as second-line anti-TB drugs, mainly for drug-resistant TB, especially MDR-TB, re-treatment and initial treatment patients who can not tolerate the first-line anti-TB drugs. However, widespread use of fluoroquinolones drugs for the treatment of other bacterial infections as well as TB, could result in the development of fluoroquinolone resistance among patients. Fluoroquinolones is also one class of drugs that defines XDR-TB, which is highly pathogenic and add to mortality incrementally, posing a threat for global health system. In order to provide information for better case management, so as to minimize the further spread of drug-resistant TB, the study was performed to investigate the prevalence of drug-resistant tuberculosis and to assess the risk factors associated with fluoroquinolone resistance among pulmonary TB patients.Methods:A retrospectively study was conducted in Shandong Provincial Chest Hospital, a major TB referral hospital. In this study, the prevalence of anti-TB drug reisitance were reviewed among pulmonary TB patients who received inpatient treatment between January 2010 and October 2014, and for whom drug susceptibility testing (DST) results were available. All available medical records for these patients were reviewed and analyzed, to determine the risk factors associated with fluoroquinolone resistance. Statistical analysis was performed using SPSS software, version 16.0. Predictors of fluoroquinolone resistance were identified by univariate and multivariate logistic regression analysis using clinical variables. The odds ratios (OR) and the 95% confidence interval (CI) and p-values for individual variables were obtained using a logistic regression model. To assess the discriminatory ability of the model, we calculated the c statistic, which represents the area under the receiver operating characteristic (ROC) curve.Results:1. The prevalence of drug resistance TB was 29.7%. A total of 122 (6.2%) patients were MDR-TB, and 27 patients (1.4%) were classified as having XDR-TB. The prevalence of drug resistance to isoniazid, rifampicin, ethambutol, streptomycin, ofloxacin, kanamycin, capreomycin, para-aminosalicylic acid was 11.4%,10.7%, 2.6%,14.2%,9.6%,2.5%,2.6%,2.2%, respectively.2. Fluoroquinolone (ofloxacin) resistance was detected in 9.6% of total patients (7.2% of new cases and 19.0% of retreated cases). The number of fluoroquinolone resistance patients is disproportionately youth (18-44 years), with a rate of 50.5%. The prevalence of resistance to fluoroquinolone was significantly higher in patients with exposure to fluoroquinolones than those without exposure. The prevalence of resistance to fluoroquinolone was significantly higher in MDR-TB patients than those non-MDR-TB patients.3. Univariable comparison showed that the following characteristics predispose the presence of MDR-TB:being a migrant from another area, re-treatment, exposure to fluoroquinolones, cavity, hemoglobin, erythrocyte sedimentation rate (ESR), hypoalbuminemia, sputum culture with other bacteria, bronchiectasis, chronic obstructive pulmonary disease, having MDR-TB, duration of the tuberculosis disease, hospital length-of-stay. On the basis of the clinical variables included in univariable comparison, the final multiple logistic regression model predicting fluoroquinolone-resistant TB were being a migrant from another area (OR 1.44,95% CI:1.05-1.98), having previous treatment (OR 7.66,95% CI:5.13-11.46), exposure to fluoroquinolones (OR 2.73,95% CI:1.97-3.77), sputum culture with other bacteria (OR 1.01,95% CI:1.00-1.02), hypoalbuminemia (OR 2.00,95% CI:1.28-3.13), having COPD (OR 3.06,95% CI:2.18-4.30), having MDR-TB (OR 1.82,95% CI: 1.14-2.91), and duration of TB disease (OR 1.01,95% CI:1.01-1.01). The receiver operating characteristic area for the death prediction probability of the two model was 0.80 (95%CI 0.77-0.83).Conclusions:The prevalence of resistance to fluoroquinolone was higher in patients with young, retreatment, exposure to fluoroquinolones and MDR-TB than those old, newly treated, without exposure and non-MDR-TB, respectively. The independent risk factors associated with fluoroquinolone resistant TB were being a migrant from another area, previously treated, exposure to fluoroquinolones, hypoalbuminemia, having COPD, having MDR-TB, having other bacteria resistance, long term duration of the disease. |
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