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Primary Drug-Resistance Pattern and Trend in Elderly Tuberculosis Patients in Shandong, China, from 2004 to 2019

Authors An Q, Song W, Liu J, Tao N, Liu Y, Zhang Q, Xu T, Li S, Liu SQ, Li Y, Yu C, Li H

Received 15 August 2020

Accepted for publication 9 October 2020

Published 13 November 2020 Volume 2020:13 Pages 4133—4145

DOI https://doi.org/10.2147/IDR.S277203

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Prof. Dr. Héctor Mora-Montes


Qiqi An,1 Wanmei Song,1 Jinyue Liu,2 Ningning Tao,3 Yao Liu,4 Qianyun Zhang,1 Tingting Xu,4 Shijin Li,1 Siqi Liu,1 Yifan Li,4 Chunbao Yu,5 Huaichen Li1,4,6

1Department of Respiratory Medicine, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, People’s Republic of China; 2Intensive Care Unit, Shandong Provincial Third Hospital, Jinan, Shandong 100191, People’s Republic of China; 3Peking Union Medical College, Beijing 100005, People’s Republic of China; 4Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, People’s Republic of China; 5Department of Respiratory Medicine, Shandong Provincial Chest Hospital, Jinan, Shandong 250013, People’s Republic of China; 6Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250355, People’s Republic of China

Correspondence: Chunbao Yu; Huaichen Li Email 13505412137@139.com; lihuaichen@163.com

Background: With an aging population, China is facing a huge burden of elderly patients with drug resistant tuberculosis (DR-TB), which has become a significant obstacle for the global TB control. There is still little study on DR-TB in the elderly in China so far. Thus, more research on the epidemiological characteristics and trend of primary DR-TB among the elderly will be necessary.
Methods: A retrospective study was conducted in Shandong, China from 2004 to 2019. We collected 12,661 primary TB cases, of which 4368 elderly (≥ 60 years) primary TB cases were involved. Clinical characteristics including age, sex, cavity, smoking, drinking, comorbidity and drug susceptibility data were collected from 36 TB prevention and control institutions of Shandong Province. Sputum samples were collected by each surveillance site, and examined in the TB Reference Laboratory of SPCH. Descriptive statistical analysis, chi-square and linear regression were used for analyzing.
Results: Among 4368 elderly patients with primary TB, the DR-TB and multi-resistant tuberculosis (MDR-TB) accounted for 17.19% and 2.29%, respectively. During 2004– 2019, the proportions of MDR-TB, polydrug resistant tuberculosis (PDR-TB), rifampin (RFP)-resistance increased by 160.00%, 18.18%, 231.82%, respectively and the rate of DR-TB among elderly patients with primary cavitary TB increased by 255%. Among the elderly with primary DR-TB during 2004– 2019, the proportion of male (from 85.19 to 89.06), cavity (from 7.41 to 46.88), RFP-resistance (from 3.70 to 21.88), and streptomycin (SM)-resistance (from 37.04 to 62.5) increased significantly (P< 0.05). And the proportion of female (from 14.81 to 10.94), non-cavity (from 92.59 to 32.81), INH-resistance (from 66.67 to 57.81) decreased significantly (P< 0.05).
Conclusion: Among the elderly, the proportions of MDR-TB, PDR-TB, RFP-resistance and cavitary DR-TB increased significantly. The pattern of DR-TB changed from female, non-cavity and INH-resistant groups to male, cavity, RFP or SM-resistant groups. For a better control on the elderly DR-TB in the future, we should pay more attention to male, smoking, drinking, chronic obstructive pulmonary disease (COPD) and diabetes subgroups and take targeted measures to control these subgroups.

Keywords: primary DR-TB, the elderly, epidemiology, chi-square regression, linear regression

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