Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China; Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China; Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, National Centre for Leprosy Control, China CDC, Nanjing, China.
Center for Global Health, School of Public Health, Nanjing Medical University; Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China; Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, National Centre for Leprosy Control, China CDC, Nanjing, China.
J Glob Antimicrob Resist. 2022 Dec;31:119-127. doi: 10.1016/j.jgar.2022.08.021. Epub 2022 Aug 31.
As the only bactericidal drug in multidrug therapy is rifampicin, monitoring of antimicrobial resistance is important in leprosy patients. Therefore, we conducted a meta-analysis on the resistance of Mycobacterium leprae (M. leprae) to rifampicin and estimated drug resistance in different therapeutic states and regions.
Embase, Medline, PubMed, and Web of Science were searched to identify studies between 1 January 1993 and 1 January 2022. Two independent reviewers extracted study data. Pooled cumulative incidences were computed using random-effects meta-analyses.
We included 32 papers describing the resistance of M. leprae to rifampicin (pooled cumulative incidences, 11% [95% confidence interval {CI}, 7% to 15%]). Therapeutic states and regional distribution were obtained for subgroup analyses. A total of 51 of 1135 new cases (pooled incidence, 10% [95% CI, 5% to 16%]) and 81 of 733 relapsed cases (pooled incidence, 20% [95% CI, 13% to 27%]) had rifampicin resistance. A total of 139 participants, including 11 patients with rifampicin resistance (pooled incidence, 42% [95% CI, -21% to 105%]), were nonresponsive and intractable cases. The incidence of rifampicin resistance was highest in the Western Pacific (pooled incidence, 21% [95% CI, 13% to 29%]) and lowest in the Americas (pooled incidence, 4% [95% CI, 1% to 7%]).
Drug resistance testing and a robust and rigorous surveillance system are recommended to detect the prevalence of drug resistance in leprosy.
利福平是多药治疗中唯一的杀菌药物，因此监测麻风分枝杆菌（M. leprae）对抗菌药物的耐药性非常重要。为此，我们对利福平耐药性进行了荟萃分析，并评估了不同治疗阶段和地区的耐药情况。
检索 1993 年 1 月 1 日至 2022 年 1 月 1 日期间的 Embase、Medline、PubMed 和 Web of Science 数据库，纳入评估 M. leprae 对利福平耐药性的研究。由两名独立的审查员提取研究数据。采用随机效应荟萃分析计算累积发生率。
共纳入 32 篇描述 M. leprae 对利福平耐药性的研究（累积发生率为 11%[95%置信区间：7%15%]）。对亚组分析获得了治疗阶段和地区分布情况。新发病例中有 51 例（累积发生率为 10%[95%置信区间：5%16%]）和复发病例中有 81 例（累积发生率为 20%[95%置信区间：13%27%]）存在利福平耐药性。139 名参与者中包括 11 例利福平耐药患者（累积发生率为 42%[95%置信区间：-21%105%]），这些患者为无应答和难治性病例。利福平耐药率最高的地区是西太平洋（累积发生率为 21%[95%置信区间：13%29%]），最低的是美洲（累积发生率为 4%[95%置信区间：1%7%]）。
建议进行耐药性检测，并建立健全、严格的监测系统，以发现麻风病中药物耐药的流行情况。
