Analysis of influencing factors for multidrug-resistant pulmonary tuberculosis in Hainan Province from 2014 to 2020

Abstract

Objective To investigate the occurrence of multidrug-resistance among tuberculosis patients in Hainan Province from 2014 to 2020 and to analyze the influencing factors, aiming to provide reference for formulating drug-resistant tuberculosis control strategies in this region.

Methods This study collected sputum samples from the patients with pulmonary tuberculosis admitted to the Second Affiliated Hospital of Hainan Medical University from 2014 to 2020, and performed isolation and identification of Mycobacterium tuberculosis and drug susceptibility testing. After the strains were identified as positive, drug sensitivity tests were conducted, and multi-drug resistant patients were found. Clinical data was retrospectively collected, and chi-square test and unconditioned logistic regression were used to analyze the influencing factors of multidrug resistance.

Results A total of 2 672 patients underwent sputum culture, strain identification, and drug susceptibility testing in TB designated hospitals in Hainan Province from January 1, 2014 to December 31, 2020. Among them, 1 942 patients with available drug susceptibility test results and complete clinical data were enrolled, among which 398 cases with drug-resistant TB were included in the case group, and 1 544 cases without drug resistance were included in the control group. Multivariate logistic regression analysis showed that farmers, rural residence, treatment history of retreatment, irregular medication history, number of pulmonary cavities ≥3, and BMI<18.5 were independent risk factors for MDR-TB. The risk of MDR-TB in farmers was higher than that in non-farmers ( OR=1.542, 95% CI: 1.150-2.020); patients living in rural areas had a higher risk of multidrug resistance than those living in urban areas ( OR=1.445, 95% CI: 1.095-1.907); the risk of MDR in the retreatment patients was higher than that in the initial treatment patients ( OR=5.616, 95% CI: 4.250-7.421); the risk of multi-drug resistance in patients with irregular medication was higher than that in patients with regular medication ( OR=2.665, 95% CI: 2.012-3.531); the risk of multidrug resistance in patients with pulmonary cavity number ≥3 was higher than that in patients with pulmonary cavity number <3 ( OR=5.040, 95% CI: 3.768-6.740); compared with patients with BMI<18.5, patients with BMI =18.5-24.0 and BMI≥24.0 had a lower risk of multidrug resistance ( OR=0.735, 95% CI: 0.555-0.975 and OR=0.447, 95% CI: 0.225-0.888, respectively).

Conclusions Retreatment, farmer occupation, rural residence, irregular medication and low BMI may be the risk factors for multidrug resistance in Hainan Province.

Abstract

摘要： 目的 了解海南省 2014—2020 年肺结核患者发生耐多药情况, 分析其影响因素, 为制定本地区耐药结核病 控制策略提供参考依据。 方法 收集 2014—2020 年海南医学院第二附属医院住院肺结核患者痰标本, 对痰标本进行 结核分枝杆菌分离培养和鉴定, 对阳性菌株进行药物敏感性实验, 发现耐多药患者, 回顾性收集患者的临床资料, 应用 χ ² 检验、非条件 Logistic 回归分析患者的耐多药发生的影响因素。 结果 2014 年 1 月 1 日— 2020 年 12 月 31 日在海 南省结核病定点医院进行痰培养、菌种鉴定及药物敏感性试验共 2 672 例, 有药物敏感性试验结果明确且临床资料完 整的 1 942例, 检出 398例耐多药肺结核患者为病例组, 1 544例为非耐多药肺结核患者为对照组。多因素Logistic 回归 分析, 职业为农民、居住地为农村、治疗史为复治、有不规律服药史、肺部空洞个数≥3、BMI<18.5是耐多药肺结核发生的 独立危险因素, 农民发生耐多药的风险较非农民高( OR=1.542, 95% CI: 1.150~2.020); 居住地为农村患者发生耐多药的 风险较城镇患者高( OR=1.445, 95% CI: 1.095~1.907); 复治患者发生耐多药的风险较初治患者高( OR=5.616, 95% CI: 4.250~7.421); 不规律服药患者发生耐多药的风险较规律服药患者高( OR=2.665, 95% CI: 2.012~3.531); 肺部空洞个数 ≥3 患者发生耐多药的风险较肺部空洞个数<3 患者高( OR=5.040, 95% CI: 3.768~6.740); 与 BMI<18.5 患者相比, BMI= 18.5~<24.0 和≥24.0 患者发生耐多药的风险较低( OR=0.735, 95% CI: 0.555~0.975)和( OR=0.447, 95% CI: 0.225~0.888)。 结论 复治、职业为农民、居住地为农村、不规律用药和 BMI偏低是海南省耐多药肺结核发生的影响因素, 应加强此类 患者的监测。