Drug resistance and clinical characteristics of pediatric and adolescent tuberculosis: A multicenter retrospective study in China

Background Pediatric tuberculosis (TB) management remains an underemphasized area plagued by diagnostic and treatment challenges that are compounded further due to rising levels of drug-resistant tuberculosis (DR-TB). Even though TB incidence is high in China, limited data exists on pediatric and adolescent DR-TB across local settings. Objectives This retrospective study aimed to characterize the prevalence, clinical features, and treatment outcomes of pediatric DR-TB over a 10-year period. Methods Medical records of 153 children and adolescents (≤18 years) diagnosed with TB were reviewed. Drug susceptibility testing (DST), GeneXpert, clinical features, and treatment outcomes were analyzed. Multivariable logistic regression and Kaplan-Meier survival analysis were employed. Results DR-TB accounted for 30.1% of cases, including 21.7% multidrug-resistant TB (MDR-TB) and 10.9% extensively drug-resistant TB (XDR-TB). DR-TB was associated with residence in high-burden areas and extrapulmonary disease. GeneXpert positivity was significantly higher in DR-TB patients (67.4%, p Conclusions High DR-TB burden, delayed diagnosis, and inferior outcomes in pediatric patients underscore the need for routine DST, wider access to molecular diagnostics, and child-friendly second-line regimens. Policy changes focused on decentralizing diagnostic services and adopting WHO-endorsed pediatric regimens are urgently required.