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Improvements needed in infection control, treatment, detection of MDR-TB in China
Xue He G. Emerg Infect Dis. 2011;doi:10.3201/eid1710.110546.
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Most multidrug-resistant tuberculosis cases in China were associated with the Beijing genotype and lower socioeconomic status, according to officials of the Chinese CDC.
Of 1,530 Mycobacterium tuberculosis isolates gathered from the study cohort, 6.5% were MDR-TB. The Beijing genotype was identified in 94% of MDR-TB isolates and 79% of the pan-susceptible isolates.
In the case-control study, officials set out to assess the risk factors for MDR-TB and estimated the percentage of cases from recent transmission among patients with MDR-TB (n=100) and patients with the pan-sensitive TB strain (n=97) from the Shandong Provincial Tuberculosis Hospital between April 2007 and July 2009.
Overall, 36.3% of MDR-TB cases showed resistance to one or more first-line therapies. Of these, 20.5% were resistant to one therapy. Compared with 6.5% of MDR isolates that were resistant to one or more therapies, 9.3% of non–MDR-TB isolates were resistant to one or more therapies.
Multivariate analysis revealed an independent association between having the Beijing genotype, TB re-treatment, having no health insurance, having symptoms that lasted 3 or more months before first hospital visit and being a farmer.
“Our study highlights the challenges of controlling MDR-TB in China,” Guang Xue He, MD, MSc, senior researcher at the National Center for Tuberculosis Control and Prevention at the Chinese CDC in Beijing, and colleagues wrote in the study. “Without early diagnosis and effective treatment, these new cases will continue to generate further infections in the community. China must urgently scale up prevention of MDR-TB through better infection control, enhancement of directly observed treatments, universal use of appropriate diagnosis and treatment for MDR-TB. Similarly, Beijing strains continue to predominate and to be associated with MDR-TB, meaning that more dedicated research is needed to understand why these strains have survived and thrived in China, as well as other countries.”
Disclosure: This study was supported by the China National Key Project (2008ZX10003-009, 2009ZX10004-714; Beijing, China).
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