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 < 0.001). DR-TB patients had longer treatment duration (median 12 months) and lower cure rates (67.4% vs. 92.5%, p < 0.001). Kaplan-Meier analysis showed treatment success rates diverging after 10 months. HRZE was significantly protective against poor outcomes (OR = 0.032, p = 0.017), and bedaquiline-based regimens showed a positive trend.

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.