Drug resistance beyond extensively drug-resistant tuberculosis: individual patient data meta-analysis

ABSTRACTThe emergence and transmission of extensively drug-resistant tuberculosis (XDR-TB) pose an increasing threat to global TB control. This study aimed to identify the patterns of evolution and transmission dynamics of XDR-TB in populations in a region of China where TB is highly endemic. We analyzed a total of 95 XDR-TB isolates collected from 2003 to 2009 in Chongqing, China. Eight drug resistance genes covering 7 drugs that define XDR-TB were amplified by PCR followed by DNA sequencing. Variable-number tandem repeat 16-locus (VNTR-16) genotyping and genotypic drug resistance profiles were used to determine the evolution or transmission patterns of XDR-TB strains. Our results indicated that the Beijing genotype was predominant (85/95 [89.5%]) in XDR-TB strains, and as many as 40.0% (38/95) of the isolates were distributed into 6 clusters based on VNTR-16 genotyping and drug resistance mutation profiles. All isolates of each cluster harbored as many as six identical resistance mutations in the drug resistance genesrpoB,katG,inhApromoter,embB,rpsL, andgidB. Among the nine cases with continuous isolates from multidrug-resistant (MDR) to XDR-TB, 4 cases represented acquired drug resistance, 4 cases were caused by transmission, and 1 case was due to exogenous superinfection. The XDR-TB epidemic in China is mainly caused by a high degree of clonal transmission, but evolution from MDR to XDR and even superinfection with a new XDR strain can also occur.

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Treatment Outcomes in Global Systematic Review and Patient Meta-Analysis of Children with Extensively Drug-Resistant Tuberculosis

Emerging Infectious Diseases ◽

10.3201/eid2503.180852 ◽

2019 ◽

Vol 25 (3) ◽

pp. 441-450 ◽

Cited By ~ 4

Author(s):

Muhammad Osman ◽

Elizabeth P. Harausz ◽

Anthony J. Garcia-Prats ◽

H. Simon Schaaf ◽

Brittany K. Moore ◽

...

Keyword(s):

Systematic Review ◽

Treatment Outcomes ◽

Meta Analysis ◽

Drug Resistant ◽

Drug Resistant Tuberculosis ◽

Resistant Tuberculosis ◽

Extensively Drug Resistant

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The emerging threat of pre-extensively drug-resistant tuberculosis in West Africa: preparing for large-scale tuberculosis research and drug resistance surveillance

BMC Medicine ◽

10.1186/s12916-016-0704-5 ◽

2016 ◽

Vol 14 (1) ◽

Cited By ~ 20

Author(s):

Florian Gehre ◽

Jacob Otu ◽

Lindsay Kendall ◽

Audrey Forson ◽

Awewura Kwara ◽

...

Keyword(s):

Drug Resistance ◽

West Africa ◽

Large Scale ◽

Drug Resistant ◽

Drug Resistant Tuberculosis ◽

Resistant Tuberculosis ◽

Extensively Drug Resistant

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Treatment Outcomes among Patients with Extensively Drug‐Resistant Tuberculosis: Systematic Review and Meta‐Analysis

Clinical Infectious Diseases ◽

10.1086/653115 ◽

2010 ◽

Vol 51 (1) ◽

pp. 6-14 ◽

Cited By ~ 154

Author(s):

Karen R. Jacobson ◽

Dylan B. Tierney ◽

Christie Y. Jeon ◽

Carole D. Mitnick ◽

Megan B. Murray

Keyword(s):

Systematic Review ◽

Treatment Outcomes ◽

Meta Analysis ◽

Drug Resistant ◽

Drug Resistant Tuberculosis ◽

Resistant Tuberculosis ◽

Extensively Drug Resistant

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Prevalence of Drug-Resistant Tuberculosis in Sudan: A Systematic Review and Meta-Analysis

Antibiotics ◽

10.3390/antibiotics10080932 ◽

2021 ◽

Vol 10 (8) ◽

pp. 932

Author(s):

Khalid Hajissa ◽

Mahfuza Marzan ◽

Mubarak Ibrahim Idriss ◽

Md Asiful Islam

Keyword(s):

Systematic Review ◽

Drug Resistance ◽

Meta Analysis ◽

Treatment Strategies ◽

Drug Resistant ◽

Drug Resistant Tuberculosis ◽

Tb Control ◽

Resistant Tuberculosis ◽

Pooled Prevalence ◽

Critical Issues

Drug-resistant tuberculosis (DR-TB) is still one of the most critical issues impeding worldwide TB control efforts. The aim of this systematic review and meta-analysis was to give an updated picture of the prevalence of DR-TB in Sudan. A comprehensive systematic search was performed on four electronic databases (PubMed, Scopus, Web of Science and Google Scholar) to identify all published studies reporting prevalence data of DR-TB in Sudan. Sixteen eligible studies published during 2002–2020 were included. Using meta-analysis of proportions, the pooled prevalence of TB cases with resistance to any anti-TB drugs was 47.0% (95% CI: 35.5–58.6%). The overall prevalence of mono, multi, poly and extensive drug resistance were estimated to be 16.2% (95% CI: 9.0–23.4%), 22.8% (95% CI: 16.0–29.7%), 6.8% (95% CI: 0.5–13.0%) and 0.7% (95% CI: 0–2.1%), respectively. Considering any first-line anti-TB drugs, the resistance prevalence was highest for isoniazid (32.3%) and streptomycin (31.7%), followed by rifampicin (29.2%). In contrast, resistance against second-line drugs was reported for only two antibiotics, namely, ofloxacin (2.1%) and kanamycin (0.7%). Of note, the resistance profile of the previously treated patients was found to be remarkably high compared with the newly diagnosed TB patients. The relatively high prevalence estimation of anti-TB drug resistance warrants strengthening TB control and treatment strategies in Sudan.

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Drug resistance profile among multi-drug resistant tuberculosis patients at diagnosis and correlation with history of anti-tubercular treatment in a tertiary care center

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20195251 ◽

2019 ◽

Vol 6 (6) ◽

pp. 1918

Author(s):

Rahul Kumar ◽

Rajiv Garg ◽

Silpa Kshetrimayum ◽

Amita Jain

Keyword(s):

Drug Resistance ◽

Drug Sensitivity ◽

Drug Resistant ◽

Second Line ◽

Drug Resistant Tuberculosis ◽

Resistant Tuberculosis ◽

Extensively Drug Resistant ◽

Primary Drug Resistance ◽

Mdr Tb ◽

History Of

Background: Drug Resistant Tuberculosis (DR-TB) is a major threat to the realization of the goal of a TB free world in the near future. It is important to study the reasons for the increasing number of such cases so that effective action can be taken to control this growing epidemic.Methods: Sputum from 36 patients diagnosed with acquired pulmonary Multidrug Resistant Tuberculosis (MDR-TB) were subjected to first- and second-line Drug Sensitivity Testing (DST) after liquid culture in mycobacterium growth Indicator Tube (MGIT). Primary MDR-TB cases were excluded. The relation of the drug sensitivity profile with the history of prior treatment taken was statistically analysed.Results: Majority of the patients had received appropriate treatment, and most had adhered to prescribed treatment. Among the 36 patients, 24(66.7%) were found to be Pre-Extensively Drug Resistant (Pre-XDR-TB) and 4(11.1%) were extensively drug resistant XDR-TB cases. Inappropriate prescription of fluoroquinolone (FQ) was found to be most common. Prior intake of any drug was not found to significantly affect subsequent resistance to that drug.Conclusions: Fluoroquinolone resistance is quite common in patients with DR-TB (66.7%). This study did not find the prior use of FQ or any other drug to significantly affect subsequent resistance to the drug. Primary drug resistance is thus a major concern. 11.1% patients were found to be XDR-TB cases. Hence DST for first- and second-line drugs should be done at the time of diagnosis to avoid failure of treatment with a predesigned regimen.

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