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Meta-Analysis
. 2023 Jul:132:50-63.
doi: 10.1016/j.ijid.2023.04.392. Epub 2023 Apr 16.

Epidemiology of extensively drug-resistant tuberculosis among patients with multidrug-resistant tuberculosis: A systematic review and meta-analysis

Getu Diriba  1 , Ayinalem Alemu  2 , Bazezew Yenew  2 , Habteyes Hailu Tola  3 , Dinka Fikadu Gamtesa  2 , Hilina Mollalign  2 , Kirubel Eshetu  4 , Shewki Moga  2 , Saro Abdella  2 , Getachew Tollera  2 , Abebaw Kebede  5 , Mesay Hailu Dangisso  2
Affiliations
Meta-Analysis

Epidemiology of extensively drug-resistant tuberculosis among patients with multidrug-resistant tuberculosis: A systematic review and meta-analysis

Getu Diriba et al. Int J Infect Dis. 2023 Jul.

Abstract

Objectives: To estimate the pooled proportion of extensively drug-resistant tuberculosis (XDR-TB) and pre-extensively drug-resistant tuberculosis (pre-XDR-TB) in patients with multidrug-resistant TB (MDR-TB).

Methods: We systematically searched articles from electronic databases: MEDLINE (PubMed), ScienceDirect, and Google Scholar. We also searched gray literature from the different literature sources main outcome of the review was either XDR-TB or pre-XDR-TB in patients with MDR-TB. We used the random-effects model, considering the substantial heterogeneity among studies. Heterogeneity was assessed by subgroup analyses. STATA version 14 was used for analysis.

Results: A total of 64 studies that reported on 12,711 patients with MDR-TB from 22 countries were retrieved. The pooled proportion of pre-XDR-TB was 26% (95% confidence interval [CI]: 22-31%), whereas XDR-TB in MDR-TB cases was 9% (95% CI: 7-11%) in patients treated for MDR-TB. The pooled proportion of resistance to fluoroquinolones was 27% (95% CI: 22-33%) and second-line injectable drugs was 11% (95% CI: 9-13%). Whereas the pooled resistance proportions to bedaquiline, clofazimine, delamanid, and linezolid were 5% (95% CI: 1-8%), 4% (95% CI: 0-10%), 5% (95% CI; 2-8%), and 4% (95% CI: 2-10%), respectively.

Conclusion: The burden of pre-XDR-TB and XDR-TB in MDR-TB were considerable. The high burdens of pre-XDR-TB and XDR-TB in patients treated for MDR-TB suggests the need to strengthen TB programs and drug resistance surveillance.

Keywords: Extensively drug-resistant tuberculosis; Multidrug-resistant tuberculosis; Pre-extensively drug-resistant tuberculosis.

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Conflict of interest statement

Declaration of competing interests The authors have no competing interests to declare.

Figures

Figure 1.
Figure 1.
Flowchart describing the selection of studies for the systematic review and meta-analysis of extensively drug-resistant-TB and pre- extensively drug-resistant-TB TB in globally. TB, tuberculosis.
Figure 2.
Figure 2.
Summary of pooled estimates of pre-extensively drug-resistant-tuberculosis among multi drug-resistant-tuberculosis patients. CI, confidence interval; ES, effect size. New diagnosed cases Previously treated diagnosed cases.
Figure 3.
Figure 3.
Pooled estimates of pre-extensively drug-resistant-tuberculosis among new and previous treated multi drug-resistant-tuberculosis patients. CI, confidence interval; ES, effect size.
Figure 4.
Figure 4.
Pooled estimates of extensively drug-resistant-tuberculosis among multi drug-resistant-tuberculosis patients. CI, confidence interval; ES, effect size.
Figure 5.
Figure 5.
Pooled estimates of extensively drug-resistant-tuberculosis among new and previous treated multi drug-resistant-tuberculosis patients. CI, confidence interval; ES, effect size.
Figure 6.
Figure 6.
Summary of pooled estimates of FQs resistance and SLIDs resistance among multi drug-resistant-tuberculosis patients. CI, confidence interval; ES, effect size; FQs, fluoroquinolone; SLID, second-line injectable drug.
Figure 7.
Figure 7.
Summary of the pooled prevalence of new drug resistance among multi drug-resistant-tuberculosis patients. CI, confidence interval; ES, effect size.
Figure 8.
Figure 8.
Funnel plots analyzing publication bias among studies evaluated for pre-XDR-TB and XDR-TB. XDR-TB, extensively drug-resistant-tuberculosis
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