2019-2020年广西柳州市基于全患者人群的耐药肺结核筛查策略分析OA北大核心CSTPCD

Objective:To understand the situation of drug-resistant tuberculosis(DR-TB)screening in all suspected TB patients in Liuzhou,Guangxi,and to provide a scientific basis for further optimization of screening strategies.Methods:A prospective study was conducted by selecting 6050 suspected tuberculosis patients from 5 urban districts(Chengzhong,Yufeng,Liunan,Liubei,Liujiang)and 5 counties(Liucheng,Luzhai,Rongshui,Rong'an,Sanjiang)in Liuzhou,from January 1st,2019 to December 31st,2020,in the Tuberculosis Report of Infectious Disease Surveillance System of the National Center for Disease Control and Prevention,using molecular biology techniques and phenotypic antimicrobial susceptibility test to screen for drug resistance in 2943 strains identified as Mycobacterium tuberculosis complex(MTBC),including 2514 strains in new patients and 429 strains in patients from drug-resistant high-risk groups,and the epidemiological characteristics of DR-TB and the clinical effectiveness of the two detection techniques were analyzed.Results:Of the 6050 suspected tuberculosis patients,the etiologically positive rate was 52.23％(3160/6050),the drug resistance screening rate of the etiologically positive patients was 93.13％(2943/3160),and a total of 132 strains of DR-TB were detected from 2943 strains of MTBC,with a drug-resistance detection rate of 4.49％(132/2943),among which,rifampicin-resistant tuberculosis(RR-TB)was 2.04％(60/2943),multidrug-resistant tuberculosis(MDR-TB)was 2.38％(70/2943),and extensively drug-resistant tuberculosis(XDR-TB)was 0.07％(2/2943);drug-resistant detection rate in high-risk groups(12.59％(54/429))was significantly higher than that of new patients(3.10％(78/2514),x2=76.954,P＜0.001).Among high-risk groups,drug resistance detection rate was highest in relapsed patients(32.65％(32/98)),significantly higher than that in relapsed treatment failure patients(2.63％(2/76),x2=44.106,P＜0.001).Epidemiological characteristics of DR-TB patients showed that drug-resistance rates of patients aged 65 years or older,retired,from high-risk groups,patients with a history of smoking,alcohol consumption or diabetes mellitus(5.92％(58/979),8.22％(12/146),12.59％(54/429),43.81％(46/105),38.13％(53/139),66.67％(12/18))were significant higher than patients aged 18-64 years,being farmers,new patients,without history of smoking,alcohol consumption and diabetes mellitus(3.98％(72/1810),4.10％(91/2221),3.10％(78/2514),3.03％(86/2838),2.82％(79/2804),and 4.10％(120/2925),x2 values were 9.471,10.061,76.954,393.038,385.474,and 163.457,P values were 0.009,0.039,＜0.001,＜0.001,＜0.001,and＜0.001,respectively).Conclusion:The drug-resistant detection rates in etiologically positive tuberculosis patients and high-risk groups in Liuzhou,Guangxi,were both lower than those were required by the World Health Organization.Patients being old and weak,retired,having bad behavioral habits or history of diabetes mellitus were all high-risk factors for developing DR-TB.It is recommended to enhance health education among etiologically positive patients and drug-resistant screening among drug-resistant high-risk groups.Simultaneously using both molecular biology techniques and phenotypic antimicrobial susceptibility test for drug resistance screening could significantly improve screening accuracy and diagnosis timeliness.