The current status of drug resistance and its influencing factors among pulmonary tuberculosis patients in Sichuan Province

doi:10.20199/j.issn.1672-2302.2025.06.008

Abstract

Abstract:

Objective To understand the current status of drug resistance to commonly used anti-tuberculosis drugs in pulmonary tuberculosis patients in Sichuan Province for reference for following precise prevention and control of drug-resistant tuberculosis. Methods Mycobacterium culture-positive patients enrolled in the Tuberculosis Drug Resistance Surveillance Program of Sichuan Province from January to December 2024 were selected as study subjects. The types, categories, and spectra of drug resistance to six common anti-tuberculosis drugs, including isoniazid (INH), rifampicin (RFP), levofloxacin (LFX), moxifloxacin (MFX), bedaquiline (BDQ), and linezolid (LZD), were sorted out, and the factors for drug-resistant tuberculosis were analyzed by multivariate logistic regression model. Results Among 1 388 patients, the overall drug resistance rate was 20.97% (291/1 388). The drug resistance rate in newly treated patients was 19.87% (253/1 273), which was significantly lower than that of retreated patients (33.04%, 38/115). The drug resistance rates to six common anti-tuberculosis drugs, ranking from the highest to the lowest, were as follows: INH (11.60%, 161/1 388), LFX (9.37%, 130/1 388), MFX (9.08%, 126/1 388), RFP (5.48%, 76/1 388), BDQ (2.23%, 31/1 388), and LZD (1.51%, 21/1 388). The most prevalent drug resistance profile was LFX+MFX, with a resistance rate being 6.05% (84/1 388). Multivariate logistic regression analysis showed that the patients with retreatment (OR=1.880, 95%CI: 1.228-2.837) or diagnosis delay ≥14 days (OR=1.423, 95%CI: 1.036-1.938) had a significantly higher risk to develop drug resistance, whereas those with negative smears (OR=0.718, 95%CI: 0.549-0.936) had a lower risk of developing drug resistance. Conclusion At present, the drug resistance to INH and fluoroquinolones (FQs) among pulmonary tuberculosis patients in Sichuan Province was relatively serious, and the risks of developing drug resistance is higher in patients with retreatment and delayed diagnosis. The findings suggest that it is imperative to strengthen the standardized management of retreated pulmonary tuberculosis patients, improve the timeliness and accuracy of clinical diagnosis and treatment, so as to effectively control the occurrence of drug-resistant tuberculosis in Sichuan Province.

Key words: Drug-resistant pulmonary tuberculosis, Drug sensitivity test, Influencing factors, Sichuan Province

CLC Number:

R521

LEI Hui, GAO Yuan, ZHANG Shu, HE Lu, WANG Weina, GAO Wenfeng, HE Jinge, XIA Lan. The current status of drug resistance and its influencing factors among pulmonary tuberculosis patients in Sichuan Province[J]. Journal of Tropical Diseases and Parasitology, 2025, 23(6): 358-362.

Figures/Tables 5

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耐药类型	初治（n=1 273）		复治（n=115）		合计（n=1 388）		χ²值	P值
耐药类型	耐药数（例）	耐药率（%）	耐药数（例）	耐药率（%）	耐药数（例）	耐药率（%）	χ²值	P值
耐药结核病（DR-TB）	253	19.87	38	33.04	291	20.97	11.039	0.001
单耐药结核病（MR-TB）	105	8.25	16	13.91	121	8.72	4.253	0.039
耐多药结核病（MDR-TB）	31	2.44	5	4.35	36	2.59	0.864	0.353
准广泛耐药结核病（pre-XDR-TB）	8	0.63	4	3.48	12	0.86	1.710	0.191
广泛耐药结核病（XDR-TB）	10	0.79	0	0	10	0.72	—	1.000^a

药物种类	初治（n=1 273）		复治（n=115）		合计（n=1 388）		χ²值	P值
药物种类	耐药数（例）	耐药率（%）	耐药数（例）	耐药率（%）	耐药数（例）	耐药率（%）	χ²值	P值
INH	138	10.84	23	20.00	161	11.60	8.629	0.003
RFP	65	5.11	11	9.57	76	5.48	4.052	0.044
LFX	110	8.64	20	17.39	130	9.37	9.513	0.002
MFX	107	8.41	19	16.52	126	9.08	8.418	0.004
BDQ	28	2.20	3	2.61	31	2.23	0	1.000
LZD	17	1.34	4	3.48	21	1.51	1.971	0.160

耐药谱系	初治（n=1 273）		复治（n=115）		合计（n=1 388）
耐药谱系	耐药数（例）	耐药率（%）	耐药数（例）	耐药率（%）	耐药数（例）	耐药率（%）
INH	70	5.50	7	6.09	77	5.55
INH+RFP	31	2.44	5	4.35	36	2.59
INH+RFP+LFX+MFX	7	0.55	3	2.61	10	0.72
INH+RFP+LFX+MFX+BDQ+LZD	3	0.24	0	0	3	0.22
INH+RFP+LFX+MFX+LZD	3	0.24	0	0	3	0.22
INH+RFP+LFX+LZD	2	0.16	0	0	2	0.14
INH+LFX+MFX	6	0.47	5	4.35	11	0.79
INH+LFX+MFX+BDQ	3	0.24	0	0	3	0.22
INH+BDQ	4	0.31	0	0	4	0.29
INH+BDQ+LZD	1	0.08	1	0.87	2	0.14
INH+LZD	2	0.16	0	0	2	0.14
RFP	15	1.18	2	1.74	17	1.22
LFX	6	0.47	1	0.87	7	0.50
LFX+MFX	75	5.89	9	7.83	84	6.05
MFX	3	0.24	0	0	3	0.22
MFX+BDQ	2	0.16	0	0	2	0.14
BDQ	10	0.79	1	0.87	11	0.79
BDQ+LZD	2	0.16	0	0	2	0.14
其他	8	0.63	4	3.48	12	0.86

因素	病例数（例）	敏感数（例）	耐药数（例）	χ²值	P值	因素	病例数（例）	敏感数（例）	耐药数（例）	χ²值	P值
治疗类型				11.039	<0.001	是	332	253	79
初治	1 273	1 020	253			患者来源				1.439	0.696
复治	115	77	38			直接就诊	120	90	30
年龄（岁）				2.243	0.326	转诊	910	724	186
0~17	21	19	2			追踪	336	265	71
18~64	754	589	165			其他	22	18	4
≥65	613	489	124			可疑症状				0.204	0.652
性别				1.216	0.270	有	905	712	193
男性	1 098	861	237			无	483	385	98
女性	290	236	54			肺部空洞				2.282	0.131
民族				0.020	0.887	有	1 203	943	260
汉族	1 314	1 039	275			无	185	154	31
其他	74	58	16			就诊时间				0.786	0.375
现住址				0.038	0.845	<14 d	474	381	93
农村	1 098	869	229			≥14 d	914	716	198
城镇	290	228	62			确诊时间				6.512	0.011
职业				0.137	0.711	<14 d	1 122	902	220
农民	1 086	856	230			≥14 d	266	195	71
其他	302	241	61			涂片结果				7.099	0.008
重点人群				2.109	0.147	阳性	753	575	178
否	1 056	844	212			阴性	635	522	113

因素	β值	SE值	Wald χ²值	P值	OR值(95%CI)
治疗类型
初治					1.000
复治	0.631	0.213	2.963	0.003	1.880（1.228~2.837）
确诊时间
<14 d					1.000
≥14 d	0.353	0.160	2.209	0.027	1.423（1.036~1.938）
涂片结果
阳性					1.000
阴性	-0.331	0.136	-2.433	0.015	0.718（0.549~0.936）