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. 2023 Jan 30:16:651-659.
doi: 10.2147/IDR.S394071. eCollection 2023.

Clinical and Computed Tomography Features Associated with Multidrug-Resistant Pulmonary Tuberculosis: A Retrospective Study in China

Chun-Hua Li #  1   2 , Xiao Fan #  3 , Sheng-Xiu Lv  2 , Xue-Yan Liu  1   2 , Jia-Nan Wang  2 , Yong-Mei Li  1 , Qi Li  1
Affiliations

Clinical and Computed Tomography Features Associated with Multidrug-Resistant Pulmonary Tuberculosis: A Retrospective Study in China

Chun-Hua Li et al. Infect Drug Resist. .

Abstract

Purpose: To explore the value of integrating clinical and computed tomography (CT) features to predict multidrug-resistant pulmonary tuberculosis (MDR-PTB).

Patients and methods: The study included 212 patients with MDR-PTB and 180 patients with drug-sensitive pulmonary tuberculosis (DS-PTB) who referred to our institute in China between January 2016 and March 2021. The clinical and CT characteristics were analyzed and compared between both groups. Multivariable logistic regression analysis was performed to identify independent factors that can be used to predict MDR-PTB. Furthermore, 115 patients admitted to another center from January 2019 to January 2022 were included as external validation cohort.

Results: For clinical characteristics, five parameters were significantly different between the two groups (all P < 0.05). With regard to CT features, nine parameters were significantly different between the two groups (all P < 0.05). Multivariable logistic regression analysis using the aforementioned differential features showed that male sex, retreated history, longer duration of previous anti-TB treatment, lower CD4+ T lymphocyte count, thick-walled cavity, centrilobular micronodules and tree-in-bud sign, bronchial stenosis, pleural and pericardial thickening were the most effective variations associated with MDR-PTB with an area under the curve (AUC) of 0.849 and accuracy of 78.6%. Furthermore, the external validation cohort that contains 115 patients obtained an AUC of 0.933 and accuracy of 81.7%.

Conclusion: MDR-PTB and DS-PTB have different clinical and imaging characteristics. A combined model incorporating these differential features can promptly diagnose MDR-PTB and develop subsequent therapeutic strategies.

Keywords: computed tomography; multidrug-resistant tuberculosis; tuberculosis.

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Conflict of interest statement

Chun-Hua Li and Xiao Fan shared the first authorship for this study. Yong-Mei Li and Qi Li are co-correspondence authors for this study. The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Multidrug-resistant pulmonary tuberculosis in a 32-year-old male patient. (A and B) Axial computed tomography images of the lung window indicate a thick-walled cavity (red arrow), patchy consolidation, and centrilobular micronodules and tree-in-bud sign (blue arrow) in the right upper lobe.
Figure 2
Figure 2
Multidrug-resistant pulmonary tuberculosis in a 48-year-old male patient. (A–D) Axial computed tomography images of the lung window indicate multiple cavities (red arrow), centrilobular micronodules and tree-in-bud sign (blue arrow), right main bronchus stenosis (black arrow), and right upper lobe destruction with bronchiectasis and distortion (blue arrowhead). (E and F) Axial computed tomography images of the mediastinal window indicate right pleural thickening (red arrowhead).
Figure 3
Figure 3
Multidrug-resistant pulmonary tuberculosis in a 77-year-old male patient. (A and B) Axial computed tomography images of the lung window indicate multiple thick-walled cavities (red arrow), consolidation, and centrilobular micronodules and tree-in-bud sign (blue arrow) in both lungs. (C and D) Axial computed tomography images of the mediastinal window indicate pericardial thickening (blue arrowhead) and bilateral pleural thickening (red arrowhead).
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References

    1. World Health Organization (WHO), Global tuberculosis report 2022. Geneva, Switzerland; 2022. Available from: https://www.who.int/publications/i/item/9789240061729. Accessed January 9, 2023.
    1. Karki M, Kantipudi K, Yang F, et al. Generalization challenges in drug-resistant tuberculosis detection from chest X-rays. Diagnostics. 2022;12:1889. doi:10.3390/diagnostics12010188 - DOI - PMC - PubMed
    1. Li D, He W, Chen B, Lv P. Primary multidrug-resistant tuberculosis versus drug-sensitive tuberculosis in non-HIV infected patients: comparisons of CT findings. PLoS One. 2017;12:e0176354. doi:10.1371/journal.pone.0176354 - DOI - PMC - PubMed
    1. Song Q, Guo X, Zhang L, Yang L, Lu X. New approaches in the classification and prognosis of sign clusters on pulmonary CT images in patients with multidrug-resistant tuberculosis. Front Microbiol. 2021;12:714617. doi:10.3389/fmicb.2021.714617 - DOI - PMC - PubMed
    1. Fox L, Kramer MR, Haim I, Priess R, Metvachuk A, Shitrit D. Comparison of isoniazid monoresistant tuberculosis with drug-susceptible tuberculosis and multidrug-resistant tuberculosis. Eur J Clin Microbiol Infect Dis. 2011;30:863–867. doi:10.1007/s10096-011-1167-4 - DOI - PubMed

Grants and funding

This study was supported by Chongqing medical scientific research project (Joint project of Chongqing Health Commission and Science and Technology Bureau) (2022MSXM147, 2022MSXM142) and Chongqing Health Commission Foundation (2020jstg027) of China.