Primary drug resistance among tuberculosis patients with diabetes mellitus: a retrospective study among 7223 cases in China

Wan-Mei Song; Yang Shao; Jin-Yue Liu; Ning-Ning Tao; Yao Liu; Qian-Yun Zhang; Ting-Ting Xu; Shi-Jin Li; Chun-Bao Yu; Lei Gao; Liang-Liang Cui; Yi-Fan Li; Huai-Chen Li

doi:10.2147/IDR.S217044

Primary drug resistance among tuberculosis patients with diabetes mellitus: a retrospective study among 7223 cases in China

Infect Drug Resist. 2019 Aug 2:12:2397-2407. doi: 10.2147/IDR.S217044. eCollection 2019.

Authors

Wan-Mei Song^#^{1

2}, Yang Shao^#¹, Jin-Yue Liu³, Ning-Ning Tao⁴, Yao Liu¹, Qian-Yun Zhang^{1

2}, Ting-Ting Xu¹, Shi-Jin Li^{1

2}, Chun-Bao Yu⁵, Lei Gao⁶, Liang-Liang Cui^{7

8}, Yi-Fan Li¹, Huai-Chen Li^{1

9}

Affiliations

¹ Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, People's Republic of China.
² Department of Clinical Medicine, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, People's Republic of China.
³ Department of Clinical Medicine, School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan 250200, Shandong, People's Republic of China.
⁴ Department of Clinical Medicine, Medical College, Graduate School of Peking Union Medical College, Beijing 100005, People's Republic of China.
⁵ Department of Respiratory Medicine, Shandong Provincial Chest Hospital, Jinan 250013, Shandong, People's Republic of China.
⁶ National Health Commssion Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People's Republic of China.
⁷ Department of Environmental Health, Jinan Municipal Center for Disease Control and Prevention, Jinan 250021, Shandong, People's Republic of China.
⁸ Department of Biostatistics, School of Public Health, Shandong University, Jinan 250012, Shandong, People's Republic of China.
⁹ Department of Chinese Medicine Integrated with Western Medicine, College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan 250355, Shandong, People's Republic of China.

^# Contributed equally.

Abstract

Background: Given the high burden of tuberculosis (TB) and diabetes mellitus (DM) in China and the worse outcome of TB-DM cases (refers to TB patients with diabetes), and drug-resistant tuberculosis cases (DR-TB), it is of great significance to explore the association between diabetes and primary DR-TB for TB elimination target in China. We assessed the clinical characteristics, drug-resistance profile, and increased risk of resistance among TB-DM patients across China from 2004 to 2017.

Method: 7223 cases with drug-susceptibility data were collected from Shandong, China. Categorical baseline characteristics of new TB cases were compared by DM status using Fisher's exact or Pearson Chi-square test. Univariable analysis and multivariable logistic models were used to estimate the association between diabetes and different drug-resistance profiles and the risk factors of primary drug resistance among TB-DM cases.

Result: Of 7223 newly diagnosed TB patients, 426 (5.90%) were TB-DM cases. TB-DM csaes were more likely to be older，accompanied by higher body mass index (BMI) and hypertension than TB-no DM cases (refers to TB patients without diabetes). The rates of DR-TB (21.83% vs 16.96%), polydrug resistant TB (PDR-TB, 6.10% vs 3.80%), isoniazid (INH)+streptomycin (SM)-resistant TB (4.93% vs 3.13%), and SM-resistant TB (16.20% vs 11.7%) among TB-DM group were higher than TB-no DM group, P<0.05. DM was significantly associated with any DR-TB (adjusted (aOR):1.30; 95% CI, 1.02-1.65), SM-related resistance (aOR: 1.43; 95% CI, 1.08-1.88), PDR-TB (OR: 1.57; 95% CI, 1.04-2.36; aOR: 1.59; 95% CI, 1.04-2.44), compared with pan-susceptible TB patients (P<0.05).

Conclusion: Our study indicated that TB-DM groups had a higher proportion of drug resistance than TB groups, and diabetes was identified as a risk factor of total DR, PDR, SM resistance and INH+SM resistance among newly diagnosed TB cases. Good management of diabetes and TB infection screening program among DM patients might be necessary for improving TB control in China.

Keywords: diabetes; primary drug resistance; risk factor; tuberculosis.