Rifampicin-resistant tuberculosis in Fujian Province, Southeast China: a retrospective analysis of drug resistance screening and treatment outcomes, 2019-2024.

BACKGROUNDS: Rifampicin-resistant tuberculosis (RR-TB) remains a major challenge to global TB control efforts. In Fujian Province, Southeast China, where RR-TB prevalence has been notably high, understanding epidemiological trends and treatment outcomes is crucial for optimizing interventions. This study aimed to analyze RR-TB characteristics, resistance patterns, and treatment outcomes to inform evidence-based control strategies.

METHODS: An observational study was conducted utilizing data from China's National Tuberculosis Information Management System, focusing on bacteriologically confirmed tuberculosis cases reported in Fujian Province during 2019-2024. Epidemiological characteristics, drug resistance and outcomes of RR-TB were described as frequency (n) and percentage (%). Risk factors for unsuccessful outcomes were assessed using univariate and multivariate logistic regression.

RESULTS: A total of 1,368 RR-TB patients were detected, with an overall resistance rate of 3.7%. The RR rate showed a steady decline year by year (&#x202f;=&#x202f;76.214,&#x202f;<&#x202f;0.001), mainly due to the decrease in new TB cases (&#x202f;=&#x202f;60.966,&#x202f;<&#x202f;0.001). RR-TB patients exhibited higher co-resistance to isoniazid (71.9% vs. 6.3%,&#x202f;<&#x202f;0.001) and ofloxacin (29.8% vs. 1.8%,&#x202f;<&#x202f;0.001) compared to rifampicin-sensitive TB. Of 1,056 RR-TB patients initiated on treatment, 720 had outcome data, revealing a low success rate (58.6%) due to high loss to follow-up (31.1%) and mortality (9.3%). Multivariate analysis identified male sex (&#x202f;=&#x202f;1.67,CI: 1.11-2.52,&#x202f;=&#x202f;0.014), age &#x2265;45&#x202f;years (&#x202f;=&#x202f;2.27,1.58-3.26,&#x202f;<&#x202f;0.001), high-risk group status (&#x202f;=&#x202f;1.42,: 1.04-1.94,&#x202f;=&#x202f;0.026), and occupation as farmer/worker (&#x202f;=&#x202f;2.17,: 1.10-4.26,&#x202f;=&#x202f;0.025) as independent risk factors of unsuccessful treatment.

CONCLUSION: Fujian Province has demonstrated a steady decline in rifampicin resistance rates, primarily driven by reductions in new TB cases. However, treatment inclusion rate and success rate remains suboptimal, highlighting the need for targeted interventions-including enhanced adherence support, intensive follow-up, and adverse event management-particularly for high-risk groups such as older males and manual laborers. These findings can guide tailored strategies to further reduce RR-TB burden in similar settings.