Drug-resistant tuberculosis is rising in Zhengzhou, China, according to a retrospective analysis of 9,665 clinical isolates of Mycobacterium tuberculosis collected between 2015 and 2024. The study, published as open access research in BMC Infectious Diseases, reports an overall drug resistance rate of 20.87 percent and a multidrug resistance (MDR) rate of 10.25 percent across the ten-year collection period.
The researchers performed drug susceptibility testing using the proportion method, screening each isolate for resistance to five drugs: isoniazid, rifampicin, ethambutol, streptomycin and levofloxacin. They compared differences between groups with the chi-square test and used the chi-square test for trend to assess temporal changes in resistance across the decade.
The headline finding is a significant upward trend in overall drug resistance, which rose from 17.29 percent to 22.98 percent over the ten years. Rates of single drug resistance, polydrug resistance (PDR), and resistance specifically to streptomycin and levofloxacin also increased significantly during the study period.
Not every resistance measure moved in the same direction. The MDR rate and the resistance rates to rifampicin and ethambutol did not show significant trends over time, the authors report.
Resistance was not distributed evenly across the patient population. Males showed a higher resistance rate than females, at 22.70 percent (1,528 of 6,730 isolates, 95 percent CI 21.71 to 23.72 percent) versus 16.66 percent (489 of 2,935, 95 percent CI 15.33 to 18.06 percent). The differences between these groups were statistically significant.
Age also mattered. People aged 19 to 59 had a resistance rate of 22.26 percent (1,511 of 6,788, 95 percent CI 21.27 to 23.27 percent), higher than both the group aged 18 or younger, at 17.87 percent (124 of 694, 95 percent CI 15.09 to 20.92 percent), and the group aged 60 or older, at 17.50 percent (382 of 2,183, 95 percent CI 15.93 to 19.16 percent). The authors identify males and young adults as populations with higher resistance rates who may need targeted interventions.
The study design is retrospective and confined to isolates from one Chinese city, so the figures describe local epidemiology rather than national or global patterns. Because the analysis is based on drug susceptibility testing of clinical isolates, it captures resistance present in tested samples and cannot by itself establish why resistance increased or which transmission events drove the trend.
Even with those limits, the combination of a high baseline MDR rate and a rapidly increasing share of isolates resistant to levofloxacin is what the authors call a severe drug resistance problem for the region. They conclude that the pattern signals significant challenges for the current prevention and control system, and they argue that strengthened antibiotic stewardship, alongside targeted interventions for the most affected groups, is critical to curbing further spread of drug resistance.
The authors’ data suggest that resistance to a key second-line drug is moving faster than resistance to first-line agents such as rifampicin, which did not show a significant trend in this dataset.
Subject of Research: Temporal trends and population patterns of drug resistance in Mycobacterium tuberculosis isolates from Zhengzhou, China, 2015 to 2024
Article Title: Drug resistance characteristics of Mycobacterium tuberculosis isolates obtained between 2015 and 2024 in Zhengzhou, China
Article References: Deng, M., Li, F., Ke, C., Wang, Y., Gao, L., Li, Q., Zhang, Z., Chen, Z., Chen, Y., & Ren, P. (2026). Drug resistance characteristics of Mycobacterium tuberculosis isolates obtained between 2015 and 2024 in Zhengzhou, China. BMC Infectious Diseases. https://doi.org/10.1186/s12879-026-14335-x
Image Credits: AI Generated
DOI: 10.1186/s12879-026-14335-x
Keywords: tuberculosis, drug resistance, Mycobacterium tuberculosis, multidrug resistance, levofloxacin, drug susceptibility testing, Zhengzhou, China, MDR-TB, antibiotic stewardship, epidemiology, Drug
News Source: Kristina Jarvis. (October 28, 2026). Tuberculosis drug resistance climbs in Zhengzhou over a decade. Scienmag.
