Xu Yuanhong, Li Qingfeng, Zhu Ma, Wu Xueqi, Wang Dongmei, Luo Jia, Li Yingjie, Zhong Jing, Zeng Peibin
Chengdu Public Health Clinical Center.
West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China.
Medicine (Baltimore). 2020 Oct 23;99(43):e22608. doi: 10.1097/MD.0000000000022608.
The aim of this study was to investigate the epidemiological characteristics and profile of drug-resistant tuberculosis (DR-TB) among children with TB in Sichuan province of China.From January 2015 to December 2018, microbiological culture-confirmed child TB cases (aged <15 years old) were enrolled retrospectively. Epidemiological and clinical information from these cases, and the drug susceptibility testing results of the isolates were collected and analyzed.Of 317 culture-confirmed child TB cases, 16.7% (53/317) were aged under 5 years old. 54.9% were Tibetans, and 31.9% had clear history of contact with TB patients. More than half (53.9%) were not vaccinated by Calmette-Guérin bacillus (BCG). Thirty percent (n = 95) were diagnosed as severe TB, and 92.4% (n = 293) were new cases. The ratio of severe TB in BCG vaccinated group was significant lower than that observed in unvaccinated group (P < .01). Significantly higher proportion of severe TB among Tibetans than Han child TB cases was observed in BCG unvaccinated group (P < .01). The overall rate of DR-TB in this study was 24.3% (77/317) and 17 multidrug-resistant tuberculosis (MDR-TB) cases were identified with rate of MDR-TB at 5.4% (17/317). No extensively drug-resistant case was found. Thirteen out of 17 MDR-TB cases (76.4%) were Tibetan children. The ratio of any resistance to 4 first-line drugs identified were: isoniazid (INH), 15.5%; rifampicin (RIF), 9.1%; ethambutol, 0.6% and streptomycin, 6.0%, respectively. More than half of MDR patterns were resistant to INH + RIF (9/17), followed by at least resistance to INH + RIF + streptomycin (n = 7).This was the first investigation on the epidemiological characteristics and profiles of DR-TB among child TB cases in Southwest of China. Our findings indicated a potentially high risk of TB infection to Tibetan children in the concentrated Tibetan communities of Sichuan.
本研究旨在调查中国四川省结核病患儿中耐多药结核病（DR-TB）的流行病学特征和概况。2015年1月至2018年12月，对微生物培养确诊的儿童结核病病例（年龄<15岁）进行回顾性纳入。收集并分析这些病例的流行病学和临床信息，以及分离株的药敏试验结果。在317例培养确诊的儿童结核病病例中，16.7%（53/317）年龄在5岁以下。54.9%为藏族，31.9%有明确的结核病患者接触史。超过一半（53.9%）未接种卡介苗（BCG）。30%（n = 95）被诊断为重症结核病，92.4%（n = 293）为新发病例。接种卡介苗组的重症结核病比例显著低于未接种组（P < 0.01）。在未接种卡介苗组中，藏族儿童结核病病例的重症结核病比例显著高于汉族儿童（P < 0.01）。本研究中DR-TB的总体发生率为24.3%（77/317），共鉴定出17例耐多药结核病（MDR-TB）病例，MDR-TB发生率为5.4%（17/317）。未发现广泛耐药病例。17例MDR-TB病例中有13例（76.4%）为藏族儿童。对4种一线药物的任何耐药比例分别为：异烟肼（INH），15.5%；利福平（RIF），9.1%；乙胺丁醇，0.6%；链霉素，6.0%。超过一半的MDR模式对INH + RIF耐药（9/17），其次是至少对INH + RIF + 链霉素耐药（n = 7）。这是中国西南部儿童结核病病例中DR-TB流行病学特征和概况的首次调查。我们的研究结果表明，在四川藏族聚居社区，藏族儿童感染结核病的风险可能很高。
