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Drug Resistance and Risk Factors of Bacteriologically Confirmed Tuberculosis Cases in 10 Sites - Hunan Province,
Jingwei Guo1, Jun Liang1, Yunhong Tan1
1Hunan Institute for Tuberculosis Control (Hunan Chest Hospital), Changsha City, Hunan Province, China.
What Is Already Known About This Topic?:
Tuberculosis (TB) is a deadly global infectious disease, and China has a high burden of rifampicin-resistant (RR) and multidrug-resistant (MDR) TB, according to the World Health Organization. Prior treatment, Regional disparities, demographics (age/sex), and comorbidities (e.g., diabetes) are associated with an elevated risk of drug-resistant TB.
What Is Added By This Report?:
We analyzed 25,978 bacteriologically confirmed pulmonary TB (PTB) cases in 10 sites in Hunan Province and found lower first-line drug resistance rates than national/provincial estimates (2018-2025). Retreatment, age 25-44 years, diabetes, and Lengshuitan residence were independent predictors of resistance. Resistance declined during the pandemic, rebounded slightly thereafter, and displayed a 4.0% annual decrease (statistically significant). There was notable inter-county heterogeneity (intraclass correlation coefficient=0.11). Hunan shifted to molecular testing (82.79% of susceptibility tests in 2021-2025).
What Are The Implications For Public Health Practice?:
Surveillance should be intensified for groups at high risk of drug-resistant TB, including retreatment patients, those aged 25-44 years, patients with diabetes and TB, and Lengshuitan residents. A scale-up of molecular diagnostic technologies and increased testing panels to cover isoniazid resistance for accurate resistance assessment should be included. Post-pandemic TB control interventions should continue to optimize the quality of routine surveillance data, and in-depth research on non-laboratory factors that lead to regional disparities in drug resistance rates should be performed.
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