Huang Yu, Wu Qingqing, Xu Shuiyang, Zhong Jieming, Chen Songhua, Xu Jinghang, Zhu Liping, He Haibo, Wang Xiaomeng
1 Department of Tuberculosis, Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou, China .
2 Department of Health Education, Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou, China .
Microb Drug Resist. 2017 Mar;23(2):236-240. doi: 10.1089/mdr.2016.0075. Epub 2016 Oct 18.
With 25% of the global burden, China has the highest incidence of drug-resistant tuberculosis (TB) in the world. However, surveillance data on extensively drug-resistant TB (XDR-TB) from China are scant. To estimate the prevalence of XDR-TB in Zhejiang, Eastern China, 30 of 90 TB treatment centers in Zhejiang were recruited. Patients with suspected TB who reported to the clinics for diagnosis were requested to undergo a smear sputum test. Positive sputum samples were tested for drug susceptibility. Data on anti-TB drug resistance from 1999 to 2008 were also collected to assess drug resistance trends. A total of 931 cases were recruited for drug susceptibility testing (DST). Among these, 23.6% (95% confidence interval [CI], 18.8-24.4) were resistant to any of the following drugs: isoniazid, rifampin, streptomycin, and ethambutol. Multidrug resistant (MDR) strains were identified in 5.1% of all cases (95% CI, 3.61-6.49). Among MDR-TB cases, 6.4% were XDR (95% CI, 1.7-18.6) and 8.9% (95% CI, 7.0-10.8) of all cases were resistant to either isoniazid or rifampin (but not both). Among MDR-TB cases, 23.4% (95% CI, 12.8-38.4) were resistant to either fluoroquinolones or a second-line anti-TB injectable drug, but not both. From 1999 to 2014, the percentage of MDR cases decreased significantly, from 8.6% to 5.1% (p = 0.00). The Global Fund to Fight TB program showed signs of success in Eastern China. However, drug-resistant TB, MDR-TB, and XDR-TB still pose a challenge for TB control in Eastern China. High-quality directly observed treatment, short-course, and universal DST for TB cases to determine appropriate treatment regimens are urgently needed to prevent acquired drug resistance.
中国承担着全球25%的耐药结核病负担，是全球耐药结核病发病率最高的国家。然而，中国广泛耐药结核病（XDR-TB）的监测数据却很少。为了估算中国东部浙江省XDR-TB的患病率，研究人员选取了浙江省90家结核病治疗中心中的30家。要求到诊所就诊以进行诊断的疑似结核病患者接受痰涂片检测。对痰涂片阳性样本进行药敏试验。研究人员还收集了1999年至2008年期间的抗结核药物耐药性数据，以评估耐药性趋势。共有931例患者接受了药敏试验（DST）。其中，23.6%（95%置信区间[CI]，18.8-24.4）的患者对以下任何一种药物耐药：异烟肼、利福平、链霉素和乙胺丁醇。在所有病例中，5.1%（95%CI，3.61-6.49）的患者被鉴定为耐多药（MDR）菌株。在MDR-TB病例中，6.4%为XDR（95%CI，1.7-18.6），所有病例中有8.9%（95%CI，7.0-10.8）对异烟肼或利福平耐药（但不是两者都耐药）。在MDR-TB病例中，23.4%（95%CI，12.8-38.4）对氟喹诺酮类药物或二线抗结核注射药物耐药，但不是两者都耐药。从1999年到2014年，MDR病例的百分比显著下降，从8.6%降至5.1%（p = 0.00）。抗击结核病全球基金项目在中国东部显示出成功的迹象。然而，耐药结核病、MDR-TB和XDR-TB仍然对中国东部的结核病控制构成挑战。迫切需要高质量的直接观察治疗短程疗法以及对结核病病例进行普遍的DST，以确定合适的治疗方案，从而预防获得性耐药。
