Thursday, March 10, 2016

Epidemiology and Clinical Characteristics of Pediatric Drug-Resistant Tuberculosis in Chongqing, China

To gain insight into the epidemiology of childhood drug resistant tuberculosis (DR-TB) in China that has the second largest burden of TB and the largest number of multidrug resistant (MDR) TB cases in the world, we performed the cross-sectional study to investigate drug resistance of four first-line anti-TB drugs (isoniazid, rifampicin, streptomycin and ethambutol) using Mycobacterium tuberculosis isolates from 196 culture-confirmed pediatric TB cases diagnosed in the Children’s Hospital of Chongqing Medical University, China during 2008–2013. 

Univariate and multivariate logistic regression analyses were performed to assess the associations between patient demographic and clinical characteristics and DR-and MDR-TB, respectively. Twenty-eight percent (56/196) of the study patients exhibited resistance to at least one of the four first-line anti-TB drugs tested. MDR was found in 4.6% (9/196) of the study patients. More than half (5/9, 55.6%) of the MDR cases were from a single county of Chongqing. A significant association was found between being acid-fast bacilli-smear negative and DR-TB (adjusted OR, 2.33; 95% CI, 1.13–4.80) and between having concurrent thoracic-extrathoracic involvement and MDR-TB (adjusted OR, 9.49; 95% CI, 1.05–85.92), respectively. 

The findings of this study indicate that the rate of DR is high among pediatric TB patients in Chongqing and suggest an urgent need for studies to identify MDR transmission hotspots in Chongqing, thereby contributing to the control DR- and MDR-TB epidemics in China. The study also generates new insight into the pathogenesis of DR and MDR M. tuberculosis strains and highlights the importance of studying childhood TB to the goal of global TB control.

Below:  Frequency distribution of drug-resistant patterns observed among all 196 culture-confirmed tuberculosis patients diagnosed in the Children's Hospital of Chongqing Medical University during 2008–2013. INH-isoniazid, RIF-rifampicin, EMB-ethambutol, STR-streptomycin. 

Full article at:

Qian Guo, Yun Pan, Ruixi Liu, Linlin Xing, Zhe Peng, Chaomin Zhu 
Department of Infectious Diseases, Children’s Hospital of Chongqing Medical University, Chongqing, China

Qian Guo, Yun Pan, Ruixi Liu, Linlin Xing, Zhe Peng, Chaomin Zhu 
Key Laboratory of Child Development and Disorders, Ministry of Education, Chongqing, China

Qian Guo, Yun Pan, Ruixi Liu, Linlin Xing, Zhe Peng, Chaomin Zhu 
Key Laboratory of Pediatrics in Chongqing, Chongqing, China

Zhenhua Yang 
Epidemiology Department, School of Public Health, University of Michigan, Ann Arbor, MI, United States of America

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