Risk factors and treatment outcomes of rifampicin-resistant tuberculosis in Guizhou Province from 2014 to 2018 / 中华传染病杂志

ABSTRACT

Objective:To explore the risk factors and the treatment outcomes of rifampicin-resistant tuberculosis (RR-TB) in Guizhou Province.Methods:The clinical data of 16 548 pulmonary tuberculosis patients with drug sensitivity test results registered in the Tuberculosis Information Management System in China from designated tuberculosis hospitals of 88 counties (cities, districts) in Guizhou Province from January 2014 to December 2018 were collected. The gender, age, occupation, ethnicity, patient registration classification, molecular biology or Lowenstein-Jenden (L-J) solid culture results of positive sputum culture patients, and treatment outcomes were retrospectively analyzed. Cohen′s kappa coefficient was used to analyze the consistency between molecular biology and L-J solid culture in detecting rifampin resistance. Chi-square test and non-conditional logistic regression model were used to analyze the risk factors of mono-rifampicin resistance tuberculosis and multidrug-resistant tuberculosis (MDR-TB) and the factors affecting treatment outcomes.The measurement data were compared by chi-square test or Fisher exact test. Results:The detection rate of RR-TB in the newly diagnosed cases was 6.79%(807/11 883), and that in the retreated cases was 30.01%(1 400/4 665). The drug sensitivity tests of 184 sputum culture positive RR-TB samples were performed by both L-J solid culture and molecular biology, and the rifampicin resistance detection rates were 20.65%(38/184) and 16.85%(31/184), respectively. The consistency between two methods was good ( kappa=0.697, 95% confidence interval ( CI) 0.564-0.830, P<0.01). Multivariate logistic regression analysis showed that patients aged 20 to 39 years old (odds ratio ( OR)=1.679, 95% CI 1.134-2.487) and aged 40 to 60 years old ( OR=1.526, 95% CI 1.019-2.283) were the high risk groups for MDR-TB. Treatment failure ( OR=27.753, 95% CI 22.455-34.300; OR=2.982, 95% CI 1.544-5.760, respectively), relapse and return ( OR=5.381, 95% CI 4.563-6.346; OR=3.897, 95% CI 2.901-5.234, respectively) were both high risk factors for MDR-TB and mono-rifampicin resistance tuberculosis. The treatment rate of RR-TB patients was 39.96% (396/991) from 2014 to 2016. Among 396 treatment cases, 138(34.85%) were cured and 16(4.04%) died. The patients aged>60 years old had lower cure rate (12.68%(9/71) vs 39.69%(129/325)) and higher death rate (11.27%(8/71) vs 2.46%(8/325)) than those aged ≤60 years. The differences were both statistically significant ( χ2=18.732, P<0.01; Fisher′s exact test, P=0.003). Conclusions:The RR-TB patients in Guizhou Province are mainly re-treated. Young and middle-age (20-60 years old) and treatment history are risk factors for RR-TB. The patients over 60 years old have a low cure rate and a high mortality rate. It is suggested to strengthen the screening, treatment and management of RR-TB to reduce the spread of tuberculosis.