Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.
Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.
Biomed Res Int. 2017;2017:5857369. doi: 10.1155/2017/5857369. Epub 2017 Dec 5.
Drug resistance surveillance is crucial for control of drug-resistant tuberculosis (TB). However, limited data exists on the burden of drug-resistant TB in children. The goal of this work was to generate prevalence data regarding rifampicin- (RIF-) resistant childhood TB in northern China and to test the feasibility of Xpert for surveying pediatric TB drug resistance prevalence. We enrolled 362 clinically diagnosed childhood TB patients and collected sputum, gastric lavage aspirate (GLA), bronchoalveolar lavage fluid (BALF), and cerebral spinal fluid (CSF) samples. Xpert and solid culture were utilized to detect RIF resistance. The detection rate of Xpert-positive TB among new clinically diagnosed TB cases was 38.4% (139/362), significantly higher than that of solid culture-positive TB (16.3%, 59/362, < 0.01). Notably, Xpert-positive rates differed significantly by sample type, with the highest positive rate for GLA (51.2%). The unit testing costs per RIF-resistant TB patient were $828.41 for solid culture and $761.86 for Xpert. Our data demonstrate that the prevalence of RIF resistance among childhood TB cases in our study (6.9%) is comparable to the national RIF resistance prevalence level of new cases (6.7%). In addition, Xpert is superior to the solid culture for RIF resistance survey in the childhood TB patients.
耐药监测对于耐药结核病（TB）的控制至关重要。然而，儿童耐药结核病的负担数据有限。这项工作的目的是生成关于中国北方儿童利福平（RIF）耐药性结核病患病率的数据，并检验 Xpert 用于调查儿科 TB 药物耐药性患病率的可行性。我们纳入了 362 例临床诊断为儿童结核病的患者，并收集了痰、胃液抽吸物（GLA）、支气管肺泡灌洗液（BALF）和脑脊液（CSF）样本。使用 Xpert 和固体培养来检测 RIF 耐药性。新临床诊断的结核病病例中，Xpert 阳性结核病的检出率为 38.4%（139/362），明显高于固体培养阳性结核病（16.3%，59/362）（<0.01）。值得注意的是，Xpert 的阳性率按样本类型显著不同，GLA 的阳性率最高（51.2%）。每例 RIF 耐药性结核病患者的单位检测成本，固体培养为 828.41 美元，Xpert 为 761.86 美元。我们的数据表明，本研究中儿童结核病病例的 RIF 耐药率（6.9%）与新发病例的全国 RIF 耐药率（6.7%）相当。此外，Xpert 对于儿童结核病患者的 RIF 耐药性调查优于固体培养。
