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Inadequate treatment linked to drug-resistant TB epidemic in China
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Drug-resistant tuberculosis has become an epidemic in China and has been linked to inadequate treatment across the health care system, according to researchers from the Chinese Center for Disease Control and Prevention.
“Studies have consistently identified prior treatment for tuberculosis as a risk factor for drug-resistant tuberculosis,” the researchers wrote. “Although other risk factors have been identified, they have generally not been useful in developing effective responses to this public health threat.”
The researchers conducted this study to determine the extent of the burden of drug-resistant TB in China and to identify factors related to the epidemic. They used cluster sampling to conduct the survey of patients who were previously treated for TB. They identified 3,037 new TB cases and 892 previously treated cases.
Among the patients in the sample, 5.7% of the new cases and 25.6% of the previously treated cases had multidrug-resistant TB. Among all of the patients, one-quarter of the cases were resistant to isoniazid, rifampin or both. Among the patients with MDR-TB, about 8% had extensively drug-resistant TB — resistant to isoniazid, rifampin, ofloxacin and kanamycin.
In 2007, the researchers identified 110,000 incident cases of MDR-TB and 8,200 incident cases of extensively drug-resistant TB. The highest risk for resistance was among patients with multiple treatments who had received their last treatment at a TB hospital. Ninety-nine of 226 patients with MDR-TB who had received previous treatment had not completed their last treatment.
“Addressing multidrug-resistant TB in China will require selection of treatment regimens on the basis of testing for initial drug resistance,” the researchers wrote. “It is also important to improve treatment in TB hospitals and enhance the continuity of treatment after patients leave the hospitals. Ultimately, by treating patients with drug-resistant TB, China can prevent the development of more drug-resistant forms of TB and reduce the transmission of drug-resistant TB.”
References:
Zhao Y. N Engl J Med. 2012;366:2161-2170.
Disclosures:
The researchers report no relevant financial disclosures.