Analysis of drug resistance and comorbidity in 6765 patients with culture positive pulmonary tuberculosis

doi:10.19871/j.cnki.xfcrbzz.2022.04.003

Abstract

Abstract: Objective To investigate the drug resistance and comorbidity of pulmonary tuberculosis patients in Qingdao, and provide scientific basis for the prevention and control of tuberculosis and the management of drug-resistant tuberculosis. Method A retrospective study was conducted on the relevant with pulmonary tuberculosis diagnosed clinically in or out of the Qingdao Thoracic Hospital from September 2016 to March 2021. The sputum smear and culture of the patients with sputum or alveolar lavage fluid were positive. At the same time, the laboratory drug sensitivity test was carried out. According to the test results, 6765 patients with pulmonary tuberculosis diagnosed were divided into multi drug/rifampicin resistant group and drug sensitive pulmonary tuberculosis as the control group. The Charlson comorbidity index (CCI) of the two groups was calculated, The drug resistance related factors and comorbidity of the two groups were analyzed. Result Which 346 cases were multidrug/rifampicin resistant and 6419 cases were drug sensitive pulmonary tuberculosis. Drug resistance of pulmonary tuberculosis patients and classification of tuberculosis treatment history(χ²=47.165, P<0.001), age(χ²=62.531, P<0.001), region（χ²=12.671, P<0.001） and high comorbidity(χ²=20.983,P<0.001); MDR/rifampicin resistant patients in rural areas are more likely to be complicated with high comorbidities.The incidence of diabetes from high to low was diabetes, hypertension, pulmonary heart disease, mental illness, malignant tumors and HIV infection. Multidrug resistant/rifampicin resistant combinations were higher than those of non resistant groups in diabetes(χ²=20.142,P<0.001）, mental disorders(χ²=6.266, P=0.012), malignant tumors(χ²=6.266, P=0.012) and HIV infection(χ²=4.335, P=0.037). Conclusion The high risk factors of MDR/rifampicin resistant pulmonary tuberculosis are retreatment, rural areas, aging and high comorbidity. The proportion of high comorbidity in MDR/rifampicin resistant pulmonary tuberculosis patients is higher than that in the control group. We should strengthen the intervention of high comorbidity patients, so as to improve the cure rate of MDR patients.

Key words: Pulmonary tuberculosis, Mycobacterium tuberculosis, Drug resistance, Comorbidity

Li Tongxia, Chu Yan, Lin Mei, Li Jing, Wang Bingrui, Ma Guangren. Analysis of drug resistance and comorbidity in 6765 patients with culture positive pulmonary tuberculosis[J]. Electronic Journal of Emerging Infectious Diseases, 2022, 7(4): 12-15.

References

[1] 卢春容,房宏霞,陆普选,等.WHO 2021年全球结核病报告:全球与中国关键数据分析[J/CD].新发传染病电子杂志,2021,6(4):368-372.
[2] WORLD HEALTH ORGANIZATION.Global tuberculosis report 2021[R]. World Health Organization, 2021.
[3] 陈秋奇, 邓国防. 浅议我国结核病共病及管理[J]. 中国防痨杂志,2021, 43(6):546-549.
[4] 周玉洁,吕启圆,李现文.共病及共病指数研究进展与应用展望[J].中国公共卫生,2015, 31(11):1513-1516.
[5] FEINSTEIN AR.The pre-therapeutic classification of co-morbidity in chronic disease[J], J Chronic Dis,1970,23(7):455-468.
[6] CHARLSON ME,CHARLSON RE,PETERSON JC,et al.The Charlson comorbidity index is adapted to predict costs of chronic disease in primary care patients[J].J Clin Epidemiol,2008,61(12) : 1234-1240.
[7] BANNAY A,CHAIGNOT C,BLOTIEREP O,et al.The best use of the Charlson Comorbidity Index with electronic health care database to predict mortality[J]. Med Care, 2016,54(2) : 188–194.
[8] WORLD HEALTH ORGANIZATION.Global Tuberculosis Report 2020[R]. World Health Organization, 2020.
[9] 罗一婷,翁榕星,周芳,等.2019 WHO全球结核报告:全球与中国关键数据分析[J/CD].新发传染病电子杂志,2020,5(1):47-50.
[10] 余卫业,谭卫国,陆普选.耐药肺结核的分类、分型及影像学表现[J/CD].新发传染病电子杂志,2019,4(1):42-47.
[11] 张小洋, 潘虹, 周银古, 等. 耐药结核病流行现状及其危险因素的研究进展[J]. 中国卫生检验杂志, 2020, 30(16):2043-2045.
[12] WORLD HEALTH ORGANIZATION.The world health report 2008:primary health care now more than ever[R]. Geneva: World Health Organization,2008.
[13] SIDDIQI K, STUBBS B, LIN Y, et al.TB multimorbidity: a global health challenge demanding urgent attention[J]. Int J Tuberc Lung Dis, 2021, 25(2):87-90.
[14] REIS-SANTOS B, GOMES T, MACEDO LR, et al.Prevalence and patterns of multimorbidity among tuberculosis patients in Brazil: a cross-sectional study[J]. Int J Equity Health, 2013,12:61.
[15] VALENZUELA-JIMÉNEZ H, MANRIQUE-HERNÁNDEZ EF, IDROVO AJ. Association of tuberculosis with multimorbidity and social networks[J]. J Bras Pneumol, 2017, 43(1):51-53.
[16] ONI T, YOUNGBLOOD E, BOULLE A, et al.Patterns of HIV, TB, and non-communicable disease multi-morbidity in peri-urban South Africa- a cross sectional study[J]. BMC Infect Dis, 2015, 15:20.
[17] KANG W, DU J, YANG S, et al.The prevalence and risks of major comorbidities among inpatients with pulmonary tuberculosis in China from a gender and age perspective: a large-scale multicenter observational study[J]. Eur J Clin Microbiol Infect Dis, 2020,40(4):787-800.
[18] 李智炜, 赖铿, 李铁钢, 等. 2016—2020年广州市耐药结核病患者不良治疗结局状况及其影响因素分析[J].中国防痨杂志, 2022, 44(6):600-607.
[19] YOON J, ZULMAN D, SCOTT JY, et al. Costs associated with multimorbidity among VA patients[J]. Med Care, 2014, 52 Suppl 3(Suppl 3):S31-S36.