Goyal Vishal, Kadam Vijay, Narang Prashant, Singh Vikram
Medical Affairs, Janssen India, Johnson & Johnson Pvt Ltd., Arena Space, 8th floor, Off JVLR, Jogeshwari (E), Mumbai, 400060, India.
BMC Public Health. 2017 Oct 17;17(1):817. doi: 10.1186/s12889-017-4779-5.
Drug-resistant pulmonary tuberculosis (DR-TB) is a significant public health issue that considerably deters the ongoing TB control efforts in India. The purpose of this review was to investigate the prevalence of DR-TB and understand the regional variation in resistance pattern across India from 1995 to 2015, based on a large body of published epidemiological studies.
A systematic review of published studies reporting prevalence of DR-TB from biomedical databases (PubMed and IndMed) was conducted. Meta-analysis was performed using random effects model and the pooled prevalence estimate (95% confidence interval [CI]) of DR-TB, multidrug resistant (MDR-) TB, pre-extensively drug-resistant (pre-XDR) TB and XDR-TB were calculated across two study periods (decade 1: 1995 to 2005; decade 2: 2006 to 2015), countrywide and in different regions. Heterogeneity in this meta-analysis was assessed using I statistic.
A total of 75 of 635 screened studies that fulfilled the inclusion criteria were selected. Over 40% of 45,076 isolates suspected for resistance to any first-line anti-TB drugs tested positive. Comparative analysis revealed a worsening trend in DR-TB between the two study decades (decade 1: 37.7% [95% CI = 29.0; 46.4], n = 25 vs decade 2: 46.1% [95% CI = 39.0; 53.2], n = 36). The pooled estimate of MDR-TB resistance was higher in previously treated patients (decade 1: 29.8% [95% CI = 20.7; 39.0], n = 13; decade 2: 35.8% [95% CI = 29.2; 42.4], n = 24) as compared with the newly diagnosed cases (decade 1: 4.1% [95% CI = 2.7; 5.6], n = 13; decade 2: 5.6% [95% CI = 3.8; 7.4], n = 17). Overall, studies from Western states of India reported highest prevalence of DR-TB (57.8% [95% CI = 37.4; 78.2], n = 6) and MDR-TB (39.9% [95% CI = 21.7; 58.0], n = 6) during decade 2. Prevalence of pre-XDR TB was 7.9% (95% CI = 4.4; 11.4, n = 5) with resistance to fluoroquinolone (66.3% [95% CI = 58.2; 74.4], n = 5) being the highest. The prevalence of XDR-TB was 1.9% (95% CI = 1.2; 2.6, n = 14) over the 20-year period.
The alarming increase in the trend of anti-TB drug resistance in India warrants the need for a structured nationwide surveillance to assist the National TB Control Program in strengthening treatment strategies for improved outcomes.
耐多药肺结核（DR-TB）是一个重大的公共卫生问题，严重阻碍了印度正在进行的结核病控制工作。本综述的目的是基于大量已发表的流行病学研究，调查1995年至2015年印度DR-TB的患病率，并了解全国耐药模式的区域差异。
对生物医学数据库（PubMed和IndMed）中报告DR-TB患病率的已发表研究进行系统综述。使用随机效应模型进行荟萃分析，并计算两个研究时期（第1个十年：1995年至2005年；第2个十年：2006年至2015年）全国及不同地区的DR-TB、耐多药（MDR-）TB、广泛耐药前（pre-XDR）TB和广泛耐药（XDR）-TB的合并患病率估计值（95%置信区间[CI]）。使用I统计量评估该荟萃分析中的异质性。
在635项筛查研究中，共有75项符合纳入标准并被选中。在45076株疑似对任何一线抗结核药物耐药的菌株中，超过40%检测呈阳性。比较分析显示，两个研究十年间DR-TB呈恶化趋势（第1个十年：37.7%[95%CI=29.0；46.4]，n=25；第2个十年：46.1%[95%CI=39.0；53.2]，n=36）。与新诊断病例相比，既往治疗患者中MDR-TB耐药的合并估计值更高（第1个十年：29.8%[95%CI=20.7；39.0]，n=13；第2个十年：35.8%[95%CI=29.2；42.4]，n=24）（新诊断病例第1个十年：4.1%[95%CI=2.7；5.6]，n=13；第2个十年：5.6%[95%CI=3.8；7.4]，n=17）。总体而言，印度西部各邦的研究报告显示，在第2个十年中DR-TB患病率最高（57.8%[95%CI=37.4；78.2]，n=6），MDR-TB患病率最高（39.9%[95%CI=21.7；58.0]，n=6）。pre-XDR TB患病率为7.9%（95%CI=4.4；11.4，n=5），其中对氟喹诺酮耐药率最高（66.3%[95%CI=58.2；74.4]，n=5）。20年间XDR-TB患病率为1.9%（95%CI=1.2；2.6，n=14）。
印度抗结核药物耐药趋势的惊人增长表明，需要在全国范围内进行结构化监测，以协助国家结核病控制规划加强治疗策略，改善治疗效果。
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