Rsearch On Drug-resistance Of Tuberculosis And Risk Factors In Chongqing

BackgroundTuberculosis(TB) is a serious infectious respiratory disease. The occurrence and spreading of the drug-resistant tuberculosis especially multi-drug-resistant tuberculosis(MDR-TB) is one of the main reasons of the increasing incidence of tuberculosis since the late 1980’s. According to the WHO report, global MDR-TB epidemic is serious at present. Most cases of MDR-TB were found in India and China. Mycobacterium tuberculosis high resistance and multi-drug resistant tuberculosis diseases are the important reasons for the worsening and increased mortality of TB, and have become the serious problems of prevention and treament of TB.Objective(1) This study was designed to investigate the epidemiological characteristics of patients with drug-resistant TB,provide theoretical basis for guiding rationalization and standardization of TB treatment, and improve the cure rate of TB.(2) A questionnaire survey was conducted to explore demographiccal characteristics, diagnosis and treatment history of TB,previous history of diseases, and the related risk factors of drug resistance in TB patients. The results will provide a reliable basis for the management and treatment for the patients with drug-resistant TB, to improve the prevention and control of drug-resistant TB.Methods(1) A total of 2271 cases were collected in Chongqing during 2009-2013. Drug sensitivity test of anti-tuberculosis drug was conducted to determine the drug resistance.(2) A case-control study including 202 cases(case group) of hospitalized patients with drug-resistant tuberculosis treated TB patients and 218 cases of non-drug-resistant tuberculosis patients(control group) during June to December 2013. A questionnaire survey was conducted to collect therisk factors of TB patients including demographiccal characteristics, diagnosis and treatment history of TB, previous history of diseases, and the related risk factors of drug resistance in TB patients. A logistical regression model was used to analyzed the potential risk factors of drug resistance.Results(1) The results of drug sensitive experiment showed that the total rate of drug resistance rate is 61.91%, the total rate of multi drug resistant is 26.29%, the initial, retreatment of multi drug resistant rate is 16.70% and 43.38%. The the top five average resistance rate from high to low are streptomycin(39.50%), isoniazid(33.20%),rifampicin(32.94%), para-aminosailcylicacid(31.40%), dipasic(21.53%).Drug-resistant TB patients stend to resistant to first-line anti-tuberculosis drugs and second-line anti-TB drugs and other drugs in recent five years.(2) Multivariate Logistic regression analysis showed that the potentisl risk factors of TB drug resistance include rural residence,low income / poverty family, lacking of TB knowledge education,noncompliance for anti tuberculosis treatment, the past history of tuberculosis, too many times of anti tuberculosistreatment, breaking-off during anti-tuberculosis treatment,diabetes and smoking.Conclusion(1)The rate of drug resistant tuberculosis patients is higher than the national average in some regions of Chongqing in recent five years. The situation of anti TB drug resistance is serious. We should strengthen the prevent and treatment of drug-resistance tuberculosis.(2) we should focus on the high-risk population of TB drug resistance, such as the patients from rural population, low income/poverty, lacking of TB knowledge education,noncompliance for anti tuberculosis treatment, history of tuberculosis, too many times of anti tuberculosis treatment, breaking-off during anti-tuberculosis treatment, and complicated by diabetes, smokers and so on. Taking effective intervention measures at the very beginning of TB diagnosed is very important to reduce the occurrence of drug resistance in tuberculosis.