Wan-Mei Song, Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 250021, Jinan, Shandong, PR China; Cheeloo College of Medicine, Shandong University, 250012, Jinan, Shandong, PR China
Yi-Fan Li, Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 250021, Jinan, Shandong, PR China
Jin-Yue Liu, Department of Intensive Care Unit, Shandong Provincial Third Hospital, 100191, Jinan, Shandong, PR China
Ning-Ning Tao, Department of Respiratory and Critical Care Medicine, Beijing Hospital, 100730, Beijing, PR China; Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences and Peking Union Medical College, 100730, Beijing, PR China
Yao Liu, Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 250021, Jinan, Shandong, PR China
Qian-Yun Zhang, Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 250021, Jinan, Shandong, PR China; Cheeloo College of Medicine, Shandong University, 250012, Jinan, Shandong, PR China
Ting-Ting Xu, Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 250021, Jinan, Shandong, PR China
Shi-Jin Li, Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 250021, Jinan, Shandong, PR China; Cheeloo College of Medicine, Shandong University, 250012, Jinan, Shandong, PR China
Qi-Qi An, Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 250021, Jinan, Shandong, PR China; Cheeloo College of Medicine, Shandong University, 250012, Jinan, Shandong, PR China
Si-Qi Liu, Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 250021, Jinan, Shandong, PR China; Cheeloo College of Medicine, Shandong University, 250012, Jinan, Shandong, PR China
Chun-Bao Yu, Katharine Hsu International Research Center of Human Infectious Diseases, Shandong Provincial Chest Hospital, 250013, Jinan, Shandong, PR China
Lei Gao, NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, 100730, Beijing, PR China
Cui-Xiang Yu, Department of Respiratory Medicine, Shandong Qianfoshan Hospital Affiliated to Shandong University, 250014, Jinan, Shandong Province, PR China
Min Zhang, Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 250021, Jinan, Shandong, PR China. Electronic address: Zhangmin712@sina.com
Huai-Chen Li, Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 250021, Jinan, Shandong, PR China; College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, 250355, Jinan, Shandong, PR China. Electronic address: lihuaichen@163.com

Document Type

Article

Publication Date

3-1-2020

Abstract

BACKGROUND: Although the association between diabetes mellitus (DM) and tuberculosis (TB) has been well-documented for centuries, evidence of the link between diabetes and drug resistance among previously treated TB patients remains limited and inconsistent.

METHODS: An observational study was performed that involved 1791 retreated TB-no DM patients (refers to TB cases without diabetes) and 93 retreated TB-DM patients (refers to TB cases with diabetes) in Shandong, China from 2004 to 2017. Baseline data including demographic and clinical characteristics, drug susceptibility test (DST) results, and diabetes status were collected. Categorical baseline characteristics were compared by 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.

RESULTS: Retreated TB-DM patients have a higher rate of drug resistance than TB-no DM patients (34.41% vs 25.00%, P < 0.01). Diabetes co-morbidity was significantly associated with any drug-resistant tuberculosis (DR-TB, odds ratio (OR):1.56, 95% confidence interval (CI): 1.01-2.43), multidrug resistant tuberculosis (MDR-TB, OR: 2.48, 95%CI:1.39-4.41; adjusted OR (aOR):2.94, 95%CI:1.57-5.48), isoniazid-related resistance (OR:1.71, 95%CI:1.04-2.81), rifampin-related resistance (OR:2.56, 0.54, 95%CI: 1.54-4.26; aOR:2.69, 95%CI:1.524-4.74), isoniazid + rifampin resistance (OR: 3.55, 95%CI:1.33-9.44; aOR:4.13, 95%CI:1.46-11.66), any resistance to isoniazid + streptomycin (OR:2.34, 95%CI:1.41-3.89; aOR:2.22, 95%CI:1.26-3.94), and any resistance to rifampin + isoniazid (OR:2.48, 95%CI:1.39-4.41; aOR:2.94, 95%CI: 1.57-5.48), compared with pan susceptible TB cases, P < 0.05.

CONCLUSIONS: The risk of acquired drug resistance increased significantly among retreated TB-DM patients compared with retreated TB-no DM patients, underlining the necessity of more interventions during the clinical management of TB-DM cases.

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