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Drug-resistant tuberculosis in Shanghai, China, 2000-2006: prevalence, trends and risk factors
X Shen1, K DeRiemer, Z-An Yuan
1Department of Tuberculosis Control, Shanghai Municipal Centre for Disease Control and Prevention, Key Laboratory of Medical Molecular Virology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.
Setting:
During 2000-2006, a regional anti-tuberculosis drug resistance surveillance study was conducted in Shanghai, China.
Objective:
To determine the prevalence, trends and risk factors for drug-resistant tuberculosis (TB) in Shanghai, China.
Design:
A retrospective study of all pulmonary TB patients reported in Shanghai during 2000-2006 was conducted.
Results:
Of 8419 pulmonary TB patients, 16.6% had resistance to any first-line anti-tuberculosis drug and 4.0% had multidrug resistance (MDR). The percentage of TB patients with resistance to any first-line anti-tuberculosis drug and MDR significantly increased during 2000-2003 (P=0.01 and P<0.01, respectively). After improvements in the TB control programme in 2004, the increasing trend in drug resistance was contained. Age 30-59 years, being an urban migrant and residence in an urban area of Shanghai were independently associated with resistance to any first-line drug and MDR in new cases, while age 30-59 years and being an urban migrant were independently associated with resistance to any first-line drug and MDR in previously treated cases.
Conclusions:
Drug-resistant TB and MDR-TB pose a challenge for TB control in Shanghai. Improved case management, including DOTS and appropriate treatment regimens, should be sustained to prevent further transmission and development of drug-resistant TB in this setting.
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