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. 2020 Oct 17;9(10):710.
doi: 10.3390/antibiotics9100710.

Prevalence of Antibiotic-Resistant Pulmonary Tuberculosis in Bangladesh: A Systematic Review and Meta-Analysis

Shoumik Kundu  1 , Mahfuza Marzan  2 , Siew Hua Gan  3 , Md Asiful Islam  4
Affiliations

Prevalence of Antibiotic-Resistant Pulmonary Tuberculosis in Bangladesh: A Systematic Review and Meta-Analysis

Shoumik Kundu et al. Antibiotics (Basel). .

Abstract

Resistance to anti-tuberculosis (anti-TB) antibiotics is a major public health concern for many high-TB burden countries in Asia, including Bangladesh. Therefore, to represent the overall drug-resistance pattern against TB in Bangladesh, a systematic review and meta-analysis was conducted. Databases such as PubMed, Scopus, and Google Scholar were searched to identify studies related to antibiotic-resistant TB. A total of 24 studies covering 13,336 patients with TB were secured and included. The random-effects model was used to calculate the summary estimates. The pooled prevalence of any, mono, multi, poly, and extensive anti-TB antibiotic-resistances were 45.3% [95% CI: 33.5-57.1], 14.3% [95% CI: 11.4-17.2], 22.2% [95% CI: 18.8-25.7], 7.7% [95% CI: 5.6-9.7], and 0.3% [95% CI: 0.0-1.0], respectively. Among any first and second-line anti-TB drugs, isoniazid (35.0%) and cycloserine (44.6%) resistances were the highest, followed by ethambutol (16.2%) and gatifloxacin (0.2%). Any, multi, and poly drug-resistances were higher in retreatment cases compared to the newly diagnosed cases, although mono drug-resistance tended to be higher in newly diagnosed cases (15.7%) than that in retreatment cases (12.5%). The majority (82.6%) of the included studies were of high quality, with most not exhibiting publication bias. Sensitivity analyses confirmed that all outcomes are robust and reliable. It is concluded that resistance to anti-TB drugs in Bangladesh is rampant and fast growing. Therefore, the implementation of a nationwide surveillance system to detect suspected and drug-resistant TB cases, as well as to ensure a more encompassing treatment management by national TB control program, is highly recommended.

Keywords: Bangladesh; antibiotic resistance; epidemiology; meta-analysis; prevalence; pulmonary tuberculosis; systematic review.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram showing the process of selecting eligible studies.
Figure 2
Figure 2
Funnel plots analyzing publication bias among studies evaluated (A) any-DR, (B) mono-DR, (C) multi-DR, and (D) poly-DR.
Figure 2
Figure 2
Funnel plots analyzing publication bias among studies evaluated (A) any-DR, (B) mono-DR, (C) multi-DR, and (D) poly-DR.
Figure 3
Figure 3
Prevalence of (A) any-DR, (B) mono-DR, (C) multi-DR, (D) poly-DR, and (E) extensive-DR in pulmonary tuberculosis in Bangladesh.
Figure 3
Figure 3
Prevalence of (A) any-DR, (B) mono-DR, (C) multi-DR, (D) poly-DR, and (E) extensive-DR in pulmonary tuberculosis in Bangladesh.
Figure 4
Figure 4
Anti-tuberculosis antibiotic resistance patterns in Bangladesh between 1999 and 2018.
See this image and copyright information in PMC

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