Sun Jiao, Fan Lichao, Zhao Yanping, Wu Haoyu, Li Ran, Tian Yao, Cheng Moxin, Ma Xin, Ma Yingying, Yang Xinru, Shen Adong, Yu Yanhong, Chen Yu
Tuberculosis Laboratory, Shenyang Tenth People's Hospital/Shenyang Chest Hospital, Shenyang, People's Republic of China.
Department of Tuberculosis, Shenyang Tenth People's Hospital/Shenyang Chest Hospital, Shenyang, People's Republic of China.
Infect Drug Resist. 2023 Nov 1;16:6983-6998. doi: 10.2147/IDR.S428720. eCollection 2023.
Drug-resistant tuberculosis (DR-TB) in children seriously threatens TB control. Information on the epidemiology and characteristics of DR-TB in children in China is limited. We studied data in Shenyang Tenth People's Hospital to understand the DR-TB epidemiology in children in Shenyang.
We retrospectively analyzed drug resistance testing data of pediatric TB patients between 2017 and 2021, and included 2976 clinically-diagnosed pediatric TB patients. We described the epidemiology of DR-TB and analyzed the trends of DR-TB incidence. The Kappa value was calculated to assess the agreement between MGIT 960 DST and Xpert MTB/RIF for detecting rifampicin resistance. Multivariate logistic regression was used to identify the risk factors for DR-TB in pediatric patients.
Of the 2976 TB patients, 1076 were confirmed by MGIT 960 culture and/or Xpert MTB/RIF. Among the 806 patients identified by MGIT 960 culture, 232 cases (28.78%) were DR-TB. Resistance to the six drugs was in the following order: streptomycin (21.09%), isoniazid (9.35%), rifampin (15.01%), levofloxacin (6.20%), ethambutol (4.22%), and amikacin (3.23%). Alarmingly, 12.90% were MDR-TB (104/806), including 28 (3.47%) pre-XDR-TB. Of the 1076 pediatric TB patients, 295 (27.4%) developed DR-TB to any one drug (including 69 rifampicin-resistant cases identified by Xpert MTB/RIF only). No difference was found in the incidence of pediatric DR-TB between 2017 and 2021. Among 376 patients who were positive for both methods, using the MGIT 960 DST results as the gold standard, Xpert MTB/RIF's sensitivity for detecting rifampicin resistance was 91.38% and its specificity was 94.65%.
Between 2017 and 2021, the DR-TB incidence in children remained unchanged in Shenyang. RR-TB, MDR-TB, and even Pre-XDR-TB require attention in children with drug-resistant TB. Xpert MTB/RIF helped to detect more rifampicin-resistant pediatric patients; thus Xpert MTB/RIF should be widely used as an important complementary tool to detect rifampicin-resistant TB in children.
儿童耐药结核病（DR-TB）严重威胁结核病防控。中国儿童DR-TB的流行病学和特征信息有限。我们研究了沈阳市第十人民医院的数据，以了解沈阳儿童DR-TB的流行病学情况。
我们回顾性分析了2017年至2021年期间儿科结核病患者的耐药检测数据，纳入了2976例临床诊断的儿科结核病患者。我们描述了DR-TB的流行病学情况，并分析了DR-TB发病率的趋势。计算Kappa值以评估MGIT 960药敏试验（DST）和Xpert MTB/RIF在检测利福平耐药性方面的一致性。采用多因素逻辑回归分析确定儿科患者DR-TB的危险因素。
在2976例结核病患者中，1076例通过MGIT 960培养和/或Xpert MTB/RIF确诊。在通过MGIT 960培养确诊的806例患者中，232例（28.78%）为DR-TB。对六种药物的耐药率依次为：链霉素（21.09%）、异烟肼（9.35%）、利福平（15.01%）、左氧氟沙星（6.20%）、乙胺丁醇（4.22%）和阿米卡星（3.23%）。令人担忧的是，12.90%为耐多药结核病（MDR-TB，104/806），其中28例（3.47%）为广泛耐药结核病前期（pre-XDR-TB）。在1076例儿科结核病患者中，295例（27.4%）对任何一种药物产生了DR-TB（包括仅通过Xpert MTB/RIF鉴定出的69例利福平耐药病例）。2017年至2021年期间，儿科DR-TB的发病率没有差异。在两种方法均为阳性的376例患者中，以MGIT 960 DST结果为金标准，Xpert MTB/RIF检测利福平耐药性的敏感性为91.38%，特异性为94.65%。
2017年至2021年期间，沈阳儿童DR-TB的发病率保持不变。耐利福平结核病（RR-TB）、MDR-TB甚至pre-XDR-TB在耐药结核病儿童中需要引起关注。Xpert MTB/RIF有助于检测出更多利福平耐药的儿科患者；因此，Xpert MTB/RIF应作为检测儿童利福平耐药结核病的重要补充工具广泛应用。
