Super Specialty Cancer Institute and Hospital, Lucknow, Uttar Pradesh, India.
ICMR-National Institute of Epidemiology, Ayapakkam, Chennai, Tamil Nadu - 600 077, India; Department of Statistics, Manonmaniam Sundaranar University, Abishekapatti, Tirunelveli, Tamil Nadu, India.
J Glob Antimicrob Resist. 2020 Sep;22:308-316. doi: 10.1016/j.jgar.2020.03.008. Epub 2020 Apr 1.
Drug-resistant tuberculosis (DR-TB) is a major global public health threat. India, as it shares a large fraction of the world's TB burden, is currently at a critical phase due to the rise of drug resistance. Monitoring the prevalence and patterns of drug resistance is essential to measure the progress of TB control programmes. We aimed to systematically review Indian studies on the prevalence and patterns of DR-TB among various treatment types and risk groups.
A systematic search was conducted on PubMed, Google Scholar, IndMed, major TB journals and other databases for English language articles published till March 2018 that estimated the prevalence of DR TB in new, previously treated, presumptive multidrug resistance (MDR), paediatric and HIV co-infected pulmonary TB patients. Two authors independently conducted the search, assessed study quality, and extracted the relevant data. Pooled prevalence of DR-TB and its types were calculated by DerSimonian-Laird random effects meta-analysis. Heterogeneity was investigated by sub-group and sensitivity analyses.
Ninety non-duplicate studies were included. The prevalence of MDR, any drug resistance and extensive drug resistance was 3.5%, 24.9% and 0.06% (among new) and 26.7%, 58.4% and 1.3% (among previously treated), respectively. MDR prevalence among presumptive MDR, paediatric and HIV co-infected TB patients was 23.3%, 5.1% and 18.8%, respectively. MDR prevalence among new TB patients was highest in Maharashtra and lowest in Telangana. There was high heterogeneity between the studies. Study period, place of study and zone were significantly associated with MDR prevalence.
India suffers from a significant burden of DR-TB. Its patterns and prevalence are very heterogeneous across time, region and setting. Implementation of universal drug susceptibility testing in all districts and continuous DR-TB surveillance is crucial to ensure programmatic success.
耐药结核病（DR-TB）是一个重大的全球公共卫生威胁。印度是全球结核病负担最大的国家之一，由于耐药性的上升，目前正处于一个关键阶段。监测耐药性的流行和模式对于衡量结核病控制规划的进展至关重要。我们旨在系统地回顾印度在各种治疗类型和风险群体中DR-TB 的流行率和模式的研究。
我们在 PubMed、Google Scholar、IndMed、主要结核病杂志和其他数据库中进行了系统搜索，以获取截至 2018 年 3 月发表的评估新、既往治疗、疑似耐多药（MDR）、儿科和 HIV 合并肺 TB 患者中 DR-TB 流行率的英文文章。两位作者独立进行了搜索、评估了研究质量，并提取了相关数据。采用 DerSimonian-Laird 随机效应荟萃分析计算 DR-TB 及其类型的总流行率。通过亚组和敏感性分析探讨异质性。
共纳入 90 篇非重复研究。新发病例中 MDR、任何药物耐药和广泛耐药的流行率分别为 3.5%、24.9%和 0.06%，既往治疗病例中分别为 26.7%、58.4%和 1.3%。疑似 MDR、儿科和 HIV 合并结核病患者中的 MDR 流行率分别为 23.3%、5.1%和 18.8%。新发病例中 MDR 流行率最高的是马哈拉施特拉邦，最低的是泰伦加纳邦。各研究之间存在高度异质性。研究时间、研究地点和区域与 MDR 流行率显著相关。
印度面临着严重的 DR-TB 负担。其模式和流行率在时间、区域和环境方面存在很大的异质性。在所有地区实施普遍的药物敏感性测试和持续的 DR-TB 监测对于确保规划的成功至关重要。
