Guo Qian, Pan Yun, Yang Zhenhua, Liu Ruixi, Xing Linlin, Peng Zhe, Zhu Chaomin
Department of Infectious Diseases, Children's Hospital of Chongqing Medical University, Chongqing, China.
Key Laboratory of Child Development and Disorders, Ministry of Education, Chongqing, China.
PLoS One. 2016 Mar 9;11(3):e0151303. doi: 10.1371/journal.pone.0151303. eCollection 2016.
To gain insight into the epidemiology of childhood drug resistant tuberculosis (DR-TB) in China that has the second largest burden of TB and the largest number of multidrug resistant (MDR) TB cases in the world, we performed the cross-sectional study to investigate drug resistance of four first-line anti-TB drugs (isoniazid, rifampicin, streptomycin and ethambutol) using Mycobacterium tuberculosis isolates from 196 culture-confirmed pediatric TB cases diagnosed in the Children's Hospital of Chongqing Medical University, China during 2008-2013. Univariate and multivariate logistic regression analyses were performed to assess the associations between patient demographic and clinical characteristics and DR-and MDR-TB, respectively. Twenty-eight percent (56/196) of the study patients exhibited resistance to at least one of the four first-line anti-TB drugs tested. MDR was found in 4.6% (9/196) of the study patients. More than half (5/9, 55.6%) of the MDR cases were from a single county of Chongqing. A significant association was found between being acid-fast bacilli-smear negative and DR-TB (adjusted OR, 2.33; 95% CI, 1.13-4.80) and between having concurrent thoracic-extrathoracic involvement and MDR-TB (adjusted OR, 9.49; 95% CI, 1.05-85.92), respectively. The findings of this study indicate that the rate of DR is high among pediatric TB patients in Chongqing and suggest an urgent need for studies to identify MDR transmission hotspots in Chongqing, thereby contributing to the control DR- and MDR-TB epidemics in China. The study also generates new insight into the pathogenesis of DR and MDR M. tuberculosis strains and highlights the importance of studying childhood TB to the goal of global TB control.
为深入了解中国儿童耐药结核病（DR-TB）的流行病学情况（中国结核病负担位居世界第二，耐多药结核病（MDR-TB）病例数位居世界第一），我们开展了一项横断面研究，利用2008年至2013年期间在中国重庆医科大学附属儿童医院确诊的196例经培养证实的儿童结核病患者的结核分枝杆菌分离株，调查四种一线抗结核药物（异烟肼、利福平、链霉素和乙胺丁醇）的耐药情况。分别进行单因素和多因素逻辑回归分析，以评估患者人口统计学和临床特征与DR-TB和MDR-TB之间的关联。28%（56/196）的研究患者对至少一种所检测的一线抗结核药物耐药。4.6%（9/196）的研究患者发现耐多药情况。超过一半（5/9，55.6%）的耐多药病例来自重庆的一个县。分别发现抗酸杆菌涂片阴性与DR-TB之间（调整后的比值比，2.33；95%可信区间，1.13 - 4.80）以及合并胸外-胸内受累与MDR-TB之间（调整后的比值比，9.49；95%可信区间，1.05 - 85.92）存在显著关联。本研究结果表明，重庆儿童结核病患者的耐药率较高，并提示迫切需要开展研究以确定重庆的耐多药传播热点，从而有助于控制中国的DR-TB和MDR-TB疫情。该研究还为DR和MDR结核分枝杆菌菌株的发病机制提供了新的见解，并强调了研究儿童结核病对全球结核病控制目标的重要性。
