AUTHOR=Cheng Qinglin , Xie Li , Wang Le , Lu Min , Li Qingchun , Wu Yifei , Huang Yinyan , Jia Qingjun , Zhao Gang 

TITLE=Incidence Density and Predictors of Multidrug-Resistant Tuberculosis Among Individuals With Previous Tuberculosis History: A 15-Year Retrospective Cohort Study

JOURNAL=Frontiers in Public Health

VOLUME=9

YEAR=2021

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2021.644347

DOI=10.3389/fpubh.2021.644347

ISSN=2296-2565

ABSTRACT=<p><bold>Background:</bold> To date, too little attention has been paid to monitoring and estimating the risk of incident multidrug-resistant tuberculosis (MDR-TB) among individuals with a previous tuberculosis history (PTBH). The purpose of this study was to assess the incidence of and risk factors for MDR-TB in those individuals.</p><p><bold>Methods:</bold> Between 2005 and 2020, a large, retrospective, population-based cohort study was performed in Hangzhou, China. A multivariable Cox regression model was used to evaluate independent predictors of incident MDR-TB among individuals with PTBH.</p><p><bold>Results:</bold> The incidence density of MDR-TB was 22.6 per 1,000 person-years (95% confidence level and an interval of 20.9–24.3) for individuals with PTBH. The incidence of MDR-TB increased significantly in individuals who</p><p>• were under 60 years old.</p><p>• were male.</p><p>• had a history of direct contact.</p><p>• came from low-income families.</p><p>• worked in high-risk occupations.</p><p>• lived in rural areas.</p><p>• had a retreatment TB history.</p><p>• had an unfavorable outcome in their previous treatment (<italic>P</italic> &lt; 0.05).</p><p>In addition, we found that the following factors were significantly linked to the MDR-TB risk among individuals with PTBH (<italic>P</italic> &lt; 0.05):</p><p>• sociodemographic factors such as the 21–30 and 31–40 year age groups, or a history of direct contact.</p><p>• clinical factors like passive modes of TB case finding (PMTCF), human immunodeficiency virus infection, unfavorable treatment outcomes, retreated TB history, non-standardized treatment regimens of retreatment TB patients, and duration of pulmonary cavities (DPC).</p><p>• microbiological factors, such as duration of positive sputum culture.</p><p>We also found that the 21–30 year age group, low family income, and PMTCF were significantly linked to incident MDR-TB only in males with PTBH, whilst the 41–50 year age group, extended treatment course, and DPC were significantly associated with female MDR-TB only.</p><p><bold>Conclusion:</bold> The incidence of MDR-TB was high, with a higher rate among subjects with a history of direct contact and unfavorable treatment outcomes. There was a gender difference in the incidence density and risk factors of MDR-TB among individuals with PTBH. Long-term monitoring and gender-specific risk-factor modifications should be given to individuals with PTBH.</p>