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. 2017 Aug 9;17(1):555.
doi: 10.1186/s12879-017-2652-x.

Epidemiological trends and outcomes of extensively drug-resistant tuberculosis in Shandong, China

Xiao-Chun He  1 , Ning-Ning Tao  2 , Yao Liu  2 , Xian-Xin Zhang  3 , Huai-Chen Li  4
Affiliations

Epidemiological trends and outcomes of extensively drug-resistant tuberculosis in Shandong, China

Xiao-Chun He et al. BMC Infect Dis. .

Abstract

Background: Extensively Drug-Resistant (XDR) Tuberculosis (TB) has posed a great threat to global health and finance systems, especially for developing countries with high TB and Multidrug-Resistant (MDR) TB burden.

Methods: We retrospectively analyzed HIV-uninfected TB case confirmed and treated in Shandong Provincial Chest Hospital (SPCH) between January 2008 and December 2015. Unique characteristics of XDR-TB were identified; its longitudinal changes and survival were analyzed.

Results: Between January 2008 and December 2015, a total of 144 cases were confirmed to be XDR-TB (2.5% of 5663 culture-confirmed TB cases; 27.9% of 516 MDR-TB cases). The proportion of XDR TB cases among MDR-TB cases has increased from 26.5% in 2008 to 44.5% in 2014 (Chi-Square test for trends: P < 0.01). Among the 144 XDR-TB cases, 21 patients (14.6%) had treatment success, 123 (85.1%) had poor treatment outcomes. Mortality was higher among XDR-TB cases than among MDR TB cases (8.3% vs. 3.8%, P = 0.033) and drug-susceptible TB cases (8.3% vs. 2.1%, P < 0.01).

Conclusions: XDR-TB cases comprise a substantial and increasing fraction of MDR-TB cases, causing poor treatment outcomes and high mortalities. Early drug susceptibility testing, adequate TB treatment and efficient infection control must be in place in future TB control strategies.

Keywords: Epidemiology trends; Survival; Treatment outcomes; XDR-TB.

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Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the Ethic Committee of Shandong Provincial Hospital, affiliated to Shandong University (approval number: 2016–0022).

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
TB cases in Shandong, China. NTM, nontuberculous mycobacteria; MDR, multi-drug resistant; XDR, extensively drug resistant
Fig. 2
Fig. 2
Cases of extensively drug-resistant tuberculosis (XDR-TB) and multidrug-resistant tuberculosis (MDR-TB) in Shandong, China. The percentage of XDR-TB cases in 2015 was 27.3% but was not included in the trend analysis because of incomplete follow-up drug susceptibility data for that year. Chi-Square test for linear trend, 14.097 (P < 0.01)
Fig. 3
Fig. 3
Survival among XDR-TB, MDR-TB and drug-susceptible TB cases, Shandong, China. Among patients included in the survival analysis, there were 12 deaths (11.4%) in the XDR-TB group, 14 deaths (5.4%) in the MDR TB group, and 97 deaths (2.8%) in the drug-susceptible TB group. Survival curves were compared using the log-rank test (P = 0.016 for XDR-TB vs. MDR TB and P < 0.01 for XDR-TB vs. drug-susceptible TB)
See this image and copyright information in PMC

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