Wasihun Araya Gebreyesus, Hailu Genet Gebrehiwet, Dejene Tsehaye Asmelash
Department of Medical Microbiology and Immunology, School of Medicine, Mekelle University, Mekelle, Ethiopia.
Department of Medical Microbiology and Immunology, School of Medicine, Aksum University, Aksum, Ethiopia.
Infect Dis Ther. 2021 Sep;10(3):1299-1308. doi: 10.1007/s40121-020-00368-5. Epub 2021 May 5.
Tuberculosis (TB) is a major health problem, mainly in resource-limited settings. The aim of this study was to determine the prevalence of TB and rifampicin-resistant Mycobacterium tuberculosis (RR-MTB) among presumptive tuberculosis patients using Xpert MTB/RIF assay in Eastern Amhara, Ethiopia.
A retrospective cross-sectional study was conducted among presumptive TB patients from three governmental hospitals in Amhara Regional State. Records of sputum sample results using Xpert MTB/RIF assay from January 2015 to December 2019 were investigated from registration books and analyzed using SPSS v.21.
Of the total of 26,656 (24,116 adults and 2540 children) TB presumptive patients included in the study, more than half, 14,624 (54.9%), were males and the median age was 36.87 (interquartile: 25.46-50.85 years). The majority of participants were new cases, 20,273 (76.1%), and with unknown HIV status, 18,981 (71.2%), respectively. MTB prevalence was 11% (95% CI: 9.34-12.08%) in all age groups, and 7.6% (95% CI 6.52-9.04%) among children. Of the MTB confirmed cases, prevalence of RR-MTB was 245 (8.3%) in adults and 14 (7.2%) in children. MTB infection was higher in the age groups of 18-35 years [adjusted odds ratio (AOR) = 2.17; 95% CI: 1.86-2.54, p < 0.001], 36-53 years (AOR = 1.31; 95% CI 1.11-1.54, p < 0.001), those who were relapse cases (AOR = 1.97; 95% CI 1.69-2.27, p < 0.0010), and failure cases (AOR = 4.67; 95% CI 3.36-6.50, p < 0.001). However, the age groups of 54-71 years (AOR = 0.79; 95% CI 0.65-0.95, p = 0.01) and over 71 years (AOR = 0.48; 95% CI 0.35-0.68, p < 0.001) were associated with lower MTB infection. Resistance to rifampicin was higher in the relapsed (AOR = 2.10; 95% CI 1.40-3.03, p < 0.001) and failure cases (AOR = 3.50; 95% CI 1.9-6.61, p < 001).
Prevalence of MTB and RR-MTB low. TB infection was higher in adult age groups and those who had previous TB treatment history. Similarly, resistance to rifampicin was higher among the relapsed and failure patients. Appropriate measurements in monitoring of TB treatment could reduce TB and RR-MTB in the study area.
结核病是一个主要的健康问题，在资源有限的环境中尤为突出。本研究的目的是使用Xpert MTB/RIF检测法确定埃塞俄比亚阿姆哈拉东部疑似结核病患者中结核病和耐利福平结核分枝杆菌（RR-MTB）的患病率。
对阿姆哈拉州三个政府医院的疑似结核病患者进行了一项回顾性横断面研究。从登记册中调查了2015年1月至2019年12月使用Xpert MTB/RIF检测法的痰样本结果记录，并使用SPSS v.21进行分析。
在纳入研究的总共26656名（24116名成年人和2540名儿童）结核病疑似患者中，超过一半，即14624名（54.9%）为男性，中位年龄为36.87岁（四分位间距：25.46 - 50.85岁）。大多数参与者分别为新病例，20273名（76.1%），以及HIV状态未知者，18981名（71.2%）。所有年龄组的MTB患病率为11%（95%CI：9.34 - 12.08%），儿童中为7.6%（95%CI 6.52 - 9.04%）。在MTB确诊病例中，RR-MTB的患病率在成年人中为245例（8.3%），在儿童中为14例（7.2%）。MTB感染在年龄组18 - 35岁中较高[调整优势比（AOR）= 2.17；95%CI：1.86 - 2.54，p < 0.001]，36 - 53岁（AOR = 1.31；95%CI 1.11 - 1.54，p < 0.001），复发病例（AOR = 1.97；95%CI 1.69 - 2.27，p < 0.0010）和治疗失败病例（AOR = 4.67；95%CI 3.36 - 6.50，p < 0.001）中较高。然而，年龄组54 - 71岁（AOR = 0.79；95%CI 0.65 - 0.95，p = 0.01）和71岁以上（AOR = 0.48；95%CI 0.35 - 0.68，p < 0.001）与较低的MTB感染相关。耐利福平在复发（AOR = 2.10；95%CI 1.40 - 3.03，p < 0.001）和治疗失败病例（AOR = 3.50；95%CI 1.9 - 6.61，p < 001）中较高。
MTB和RR-MTB的患病率较低。成人年龄组和有既往结核病治疗史的人群中TB感染较高。同样，复发和治疗失败患者中耐利福平的比例较高。在结核病治疗监测中采取适当措施可以降低研究地区的结核病和RR-MTB。
