Trends in and Risk Factors for Drug Resistance in Mycobacterium tuberculosis in HIV-Infected Patients
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Methods
2.2.1. Specimen Collection and Culture
2.2.2. Drug Susceptibility Test
2.3. Definition of Drug-Resistant Tuberculosis
- Drug-resistant tuberculosis (DR-TB) refers to tuberculosis that has resistance to at least one anti-tuberculosis drug.
- Mono-resistant tuberculosis (MR-TB) refers to tuberculosis that has resistance to only one anti-tuberculosis drug.
- Isoniazid-resistant tuberculosis (Hr-TB) refers to tuberculosis that has resistance to isoniazid but not concurrent resistance to rifampicin.
- Rifampicin-resistant tuberculosis (RR-TB) refers to tuberculosis that has resistance to rifampicin regardless of its sensitivity or resistance to other anti-tuberculosis drugs.
- Poly-resistant tuberculosis (PR-TB) refers to tuberculosis that has resistance to more than one kind of anti-tuberculosis drug, but not concurrent resistance to isoniazid and rifampicin.
- Multidrug-resistant tuberculosis (MDR-TB) refers to tuberculosis that has simultaneous resistance to isoniazid and rifampicin, regardless of its resistance to other anti-tuberculosis drugs.
- Pre-extensive drug-resistant tuberculosis (Pre-XDR-TB) refers to MDR-TB that has resistance to any quinolone.
- Extensive drug resistant tuberculosis (XDR-TB) refers to MDR-TB that has resistance to any quinolone and at least one of the three injectable drugs including capreomycin, kanamycin, and amikacin [6]. The traditional definition of XDR-TB was still used in this study because linezolid and bedaquiline were unavailable clinically and phenotypic susceptibility testing was not carried out in our hospital.
2.4. Statistical Analysis
3. Results
3.1. The Overall Profiles of Drug Resistance
3.2. The Trends in Drug Resistance in M. tuberculosis to the First-Line and Second-Line Anti-Tuberculosis Drugs from 2010 to 2021
3.3. Comparison of Drug Resistance Rates between Different Groups and Risk Factor Analysis in the Group of 304 Cases
3.4. Comparison of Drug Resistance Rates between Different Groups and Risk Factor Analysis in the Group of 93 Cases
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Patients with First-Line Drug Susceptibility Results (n = 304) | Patients with First-Line and Second-Line Drug Susceptibility Results (n = 93) | |
---|---|---|
Age ≥ 60 years old, n (%) | 33 (10.9) | 14 (15.1) |
Male, n (%) | 267 (87.8) | 84 (90.3) |
CD4 T cell counts ≥ 200 cells/μL, n (%) | 38 (12.5) | 12 (12.9) |
Initial treatment, n (%) | 286 (94.1) | 83 (89.2) |
Isoniazid resistance, n (%) | 35 (11.5) | 9 (9.7) |
Rifampicin resistance, n (%) | 46 (15.1) | 20 (21.5) |
Ethambutol resistance, n (%) | 38 (12.5) | 10 (10.8) |
Streptomycin resistance, n (%) | 81 (26.6) | 27 (29) |
Kanamycin resistance, n (%) | / | 4 (4.3) |
Capreomycin resistance, n (%) | / | 5 (5.4) |
Para-aminosalicylic acid resistance, n (%) | / | 7 (7.5) |
Protionamide resistance, n (%) | / | 6 (6.5) |
Amikacin resistance, n (%) | / | 4 (4.3) |
Ofloxacin resistance, n (%) | / | 19 (20.4) |
Levofloxacin resistance, n (%) | / | 16 (17.2) |
Moxifloxacin resistance, n (%) | / | 14 (15.1) |
XDR-TB, n (%) | / | 5 (5.4) |
Pre-XDR-TB, n (%) | / | 14 (15.1) |
MDR-TB, n (%) | 40 (13.2) | 17 (18.3) |
PR-TB, n (%) | 20 (6.6) | 11 (11.8) |
MR-TB, n (%) | 54 (17.8) | 12 (12.9) |
DR-TB, n (%) | 114 (37.5) | 40 (43.0) |
Gender | Age | CD4 T Cell Count (Cells/μL) | Treatment History | |||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Male | Female | χ2 | p Value | ≥60 years old | <60 years old | χ2 | p-Value | ≥200 | <200 | χ2 | p-Value | Initial Treatment | Retreatment | χ2 | p-Value | |
(n = 267) | (n = 37) | (n = 33) | (n = 271) | (n = 38) | (n = 266) | (n = 286) | (n = 18) | |||||||||
Isoniazid resistance rate | 12.40% | 5.40% | 0.94 | 0.333 | 9.10% | 11.80% | 0.03 | 0.863 | 13.20% | 11.30% | 0.005 | 0.946 | 11.90% | 5.60% | 0.2 | 0.663 |
Rifampicin resistance rate | 15.00% | 16.20% | 0.04 | 0.844 | 6.10% | 16.20% | 1.646 | 0.2 | 15.80% | 15.00% | 0.015 | 0.904 | 14.00% | 33.30% | 3.5 | 0.06 |
Streptomycin resistance rate | 26.60% | 27.00% | 0 | 0.955 | 9.10% | 28.80% | 5.836 | 0.016 | 15.80% | 28.20% | 2.618 | 0.106 | 26.90% | 22.20% | 0 | 0.871 |
Ethambutol resistance rate | 11.60% | 18.90% | 0.99 | 0.32 | 9.10% | 12.90% | 0.121 | 0.728 | 13.20% | 12.40% | 0 | 1 | 12.60% | 11.10% | 0 | 1 |
Prevalence of MDR-TB | 12.70% | 16.20% | 0.11 | 0.743 | 6.10% | 14.00% | 1.009 | 0.315 | 10.50% | 13.50% | 0.263 | 0.608 | 12.60% | 22.20% | 0.7 | 0.416 |
Prevalence of PR-TB | 7.10% | 2.70% | 0.44 | 0.509 | 6.10% | 6.60% | 0 | 1 | 7.90% | 6.40% | 0 | 1 | 7.00% | 0.00% | 0.5 | 0.502 |
Prevalence of MR-TB | 18.40% | 13.50% | 0.52 | 0.47 | 3.00% | 19.60% | 5.501 | 0.019 | 13.20% | 18.40% | 0.631 | 0.427 | 17.80% | 16.70% | 0 | 1 |
Prevalence of DR-TB | 38.20% | 32.40% | 0.46 | 0.497 | 15.20% | 40.20% | 7.889 | 0.005 | 31.60% | 38.30% | 0.65 | 0.42 | 37.40% | 38.90% | 0.2 | 0.9 |
Gender | Age | CD4 T Cell Count (Cells/μL) | Condition of Treatment | |||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Male (n = 84) | Female (n = 9) | χ2 | p-Value | ≥60 Years Old (n = 14) | <60 Years Old (n = 79) | χ2 | p-Value | ≥200 (n = 12) | <200 (n = 81) | χ2 | p-Value | Initial treatment (n = 83) | Retreatment (n = 10) | χ2 | p-Value | |
Isoniazid resistance rate | 9.5% | 11.1% | - | 1 | 7.1% | 10.1% | 0 | 1 | 8.3% | 9.9% | 0 | 1 | 9.6% | 10% | - | 1 |
Rifampicin resistance rate | 22.6% | 11.1% | 0.138 | 0.71 | 7.1% | 24.1% | 1.137 | 0.286 | 25.0% | 21.0% | 0 | 1 | 18.1% | 50% | 3.66 | 0.056 |
Streptomycin resistance rate | 10.7% | 11.1% | - | 1 | 7.1% | 11.4% | 0 | 0.996 | 16.7% | 9.9% | 0.044 | 0.834 | 27.7% | 40% | 0.21 | 0.646 |
Ethambutol resistance rate | 29.8% | 22.2% | 0.008 | 0.93 | 7.1% | 32.9% | 2.684 | 0.101 | 25.0% | 29.6% | 0 | 1 | 27.7% | 40% | 0.19 | 0.66 |
Kanamycin resistance rate | 4.8% | 0.0% | - | 1 | 0.0% | 15.1% | - | 1 | 8.3% | 3.7% | - | 0.43 | 1.2% | 30% | - | 0.003 |
Capreomycin resistance rate | 4.8% | 11.1% | - | 0.406 | 0.0% | 6.3% | - | 1 | 8.3% | 4.9% | - | 0.507 | 4.8% | 10% | - | 0.441 |
Para-aminosalicylic acid resistance rate | 6.0% | 22.2% | - | 0.136 | 7.1% | 7.6% | 0 | 1 | 8.3% | 7.4% | - | 1 | 6.0% | 20% | - | 0.163 |
Protionamide resistance rate | 7.1% | 0.0% | - | 1 | 0.0% | 7.6% | - | 0.586 | 16.7% | 4.9% | - | 0.171 | 3.6% | 30% | - | 0.015 |
Amikacin resistance rate | 4.8% | 0.0% | - | 1 | 0.0% | 5.1% | - | 1 | 8.3% | 3.7% | - | 0.43 | 2.4% | 20% | - | 0.056 |
Ofloxacin resistance rate | 21.4% | 11.1% | 0.087 | 0.768 | 14.3% | 21.5% | 0.067 | 0.796 | 25.0% | 19.8% | 0.001 | 0.97 | 16.9% | 50% | 4.16 | 0.041 |
Levofloxacin resistance rate | 17.9% | 11.1% | 0.002 | 0.964 | 14.3% | 17.7% | 0 | 1 | 25.0% | 16.0% | 0.127 | 0.721 | 13.3% | 50% | 6.08 | 0.014 |
Moxifloxacin resistance rate | 16.7% | 0.0% | 0.703 | 0.402 | 7.1% | 16.5% | 0.243 | 0.622 | 16.7% | 14.8% | 0 | 1 | 13.3% | 30% | 0.87 | 0.352 |
Prevalence of MDR-TB | 19.0% | 11.1% | 0.017 | 0.895 | 7.1% | 20.3% | 0.631 | 0.427 | 16.7% | 18.5% | 0 | 1 | 15.7% | 40% | 2.1 | 0.148 |
Prevalence of PR-TB | 11.9% | 11.1% | - | 0.944 | 7.1% | 12.7% | - | 1 | 16.7% | 11.1% | - | 0.63 | 10.8% | 20% | - | 0.336 |
Prevalence of MR-TB | 13.1% | 11.1% | 0 | 1 | 7.1% | 13.9% | 0.07 | 0.791 | 0.0% | 14.8% | 0.936 | 0.333 | 14.5% | 0% | - | 0.35 |
Prevalence of DR-TB | 44.0% | 33.3% | - | 0.727 | 21.4% | 46.8% | 3.132 | 0.077 | 33.3% | 44.4% | 0.526 | 0.468 | 41.0% | 60% | - | 0.318 |
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Le, X.; Qian, X.; Liu, L.; Sun, J.; Song, W.; Qi, T.; Wang, Z.; Tang, Y.; Xu, S.; Yang, J.; et al. Trends in and Risk Factors for Drug Resistance in Mycobacterium tuberculosis in HIV-Infected Patients. Viruses 2024, 16, 627. https://doi.org/10.3390/v16040627
Le X, Qian X, Liu L, Sun J, Song W, Qi T, Wang Z, Tang Y, Xu S, Yang J, et al. Trends in and Risk Factors for Drug Resistance in Mycobacterium tuberculosis in HIV-Infected Patients. Viruses. 2024; 16(4):627. https://doi.org/10.3390/v16040627
Chicago/Turabian StyleLe, Xiaoqin, Xueqin Qian, Li Liu, Jianjun Sun, Wei Song, Tangkai Qi, Zhenyan Wang, Yang Tang, Shuibao Xu, Junyang Yang, and et al. 2024. "Trends in and Risk Factors for Drug Resistance in Mycobacterium tuberculosis in HIV-Infected Patients" Viruses 16, no. 4: 627. https://doi.org/10.3390/v16040627
APA StyleLe, X., Qian, X., Liu, L., Sun, J., Song, W., Qi, T., Wang, Z., Tang, Y., Xu, S., Yang, J., Wang, J., Chen, J., Zhang, R., Zhu, Z., & Shen, Y. (2024). Trends in and Risk Factors for Drug Resistance in Mycobacterium tuberculosis in HIV-Infected Patients. Viruses, 16(4), 627. https://doi.org/10.3390/v16040627