The Burden of MDR/XDR Tuberculosis in Coastal Plains Population of China

BACKGROUND We conducted a first baseline survey in Jilin Province of China to determine the proportion of drug-resistant tuberculosis (TB), and to analyze risk factors associated with the emergence of drug-resistance. METHODOLOGY/PRINCIPAL FINDINGS Thirty counties in Jilin Province were randomly selected as survey sites using a stratified cluster sampling method. People enrolled in the survey were new and re-treated, smear-positive pulmonary TB patients newly enrolled in local TB control and prevention institutions during the survey period. Sputum samples were collected, and the susceptibility of bacterial strains to anti-TB drugs was analyzed by proportion method. Based on the survey results, we estimated the number of drug-resistant TB patients and analyzed the risk factors associated with the emergence of drug resistance. Of 1,174 new TB patients and 597 re-treated TB patients, 8.6% and 23.2% were multi-drug resistant (MDR)-TB patients, respectively. Approximately 12% of MDR-TB patients were extensively drug-resistant. We estimate that approximately 1,290 new MDR-TB cases develop in Jilin Province every year. Of these, 810 cases would be new patients, and 480 cases would involve re-treated patients. Risk factors associated with MDR-TB include employment status, educational background, and income level. CONCLUSIONS/SIGNIFICANCE Jilin Province remains one of the highest-burden areas in China for drug-resistant TB. The higher number of MDR-TB among new cases suggested that the transmission of drug-resistant strains in Jilin is an urgent problem in the MDR-TB control and prevention system of Jilin Province. Improving the treatment compliance of TB patients and the quality of medical care in public health institutions is urgently needed.