Reta Melese Abate, Tamene Birhan Alemnew, Abate Biruk Beletew, Mensah Eric, Maningi Nontuthuko Excellent, Fourie P Bernard
Department of Medical Microbiology, Faculty of Health Sciences, University of Pretoria, Prinshof 0084, South Africa.
Department of Medical Laboratory Science, College of Health Sciences, Woldia University, Woldia P.O. Box 400, Ethiopia.
Trop Med Infect Dis. 2022 Oct 14;7(10):300. doi: 10.3390/tropicalmed7100300.
Tuberculosis (TB) remains a significant global public health issue, despite advances in diagnostic technologies, substantial global efforts, and the availability of effective chemotherapies. , a species of pathogenic bacteria resistant to currently available anti-TB drugs, is on the rise, threatening national and international TB-control efforts. This systematic review and meta-analysis aims to estimate the pooled prevalence of drug-resistant TB (DR-TB) in Ethiopia. A systematic literature search was undertaken using PubMed/MEDLINE, HINARI, the Web of Science, ScienceDirect electronic databases, and Google Scholar (1 January 2011 to 30 November 2020). After cleaning and sorting the records, the data were analyzed using STATA 11. The study outcomes revealed the weighted pooled prevalence of any anti-tuberculosis drug resistance, any isoniazid (INH) and rifampicin (RIF) resistance, monoresistance to INH and RIF, and multidrug-resistant TB (MDR-TB) in newly diagnosed and previously treated patients with TB. A total of 24 studies with 18,908 patients with TB were included in the final analysis. The weighted pooled prevalence of any anti-TB drug resistance was 14.25% (95% confidence interval (CI): 7.05-21.44%)), whereas the pooled prevalence of any INH and RIF resistance was found in 15.62% (95%CI: 6.77-24.47%) and 9.75% (95%CI: 4.69-14.82%) of patients with TB, respectively. The pooled prevalence for INH and RIF-monoresistance was 6.23% (95%CI: 4.44-8.02%) and 2.33% (95%CI: 1.00-3.66%), respectively. MDR-TB was detected in 2.64% (95%CI: 1.46-3.82%) of newly diagnosed cases and 11.54% (95%CI: 2.12-20.96%) of retreated patients with TB, while the overall pooled prevalence of MDR-TB was 10.78% (95%CI: 4.74-16.83%). In Ethiopia, anti-tuberculosis drug resistance is widespread. The estimated pooled prevalence of INH and RIF-monoresistance rates were significantly higher in this review than in previous reports. Moreover, MDR-TB in newly diagnosed cases remained strong. Thus, early detection of TB cases, drug-resistance testing, proper and timely treatment, and diligent follow-up of TB patients all contribute to the improvement of DR-TB management and prevention. Besides this, we urge that a robust, routine laboratory-based drug-resistance surveillance system be implemented in the country.
尽管诊断技术有所进步、全球付出了巨大努力且有有效的化疗方法，但结核病（TB）仍然是一个重大的全球公共卫生问题。对目前可用抗结核药物耐药的一种病原菌正在增加，这威胁到国家和国际结核病控制工作。本系统评价和荟萃分析旨在估计埃塞俄比亚耐多药结核病（DR-TB）的合并患病率。使用PubMed/MEDLINE、HINARI、科学网、ScienceDirect电子数据库和谷歌学术（2011年1月1日至2020年11月30日）进行了系统的文献检索。在清理和整理记录后，使用STATA 11对数据进行了分析。研究结果揭示了新诊断和既往治疗过的结核病患者中任何抗结核药物耐药、任何异烟肼（INH）和利福平（RIF）耐药、对INH和RIF的单耐药以及耐多药结核病（MDR-TB）的加权合并患病率。最终分析纳入了24项研究，共18908例结核病患者。任何抗结核药物耐药的加权合并患病率为14.25%（95%置信区间（CI）：7.05 - 21.44%），而任何INH和RIF耐药的合并患病率分别在15.62%（95%CI：6.77 - 24.47%）和9.75%（95%CI：4.69 - 14.82%）的结核病患者中发现。INH和RIF单耐药的合并患病率分别为6.23%（95%CI：4.44 - 8.02%）和2.33%（95%CI：1.00 - 3.66%）。在新诊断病例中检测到MDR-TB的比例为2.64%（95%CI：1.46 - 3.82%），在复治结核病患者中为11.54%（95%CI：2.12 - 20.96%），而MDR-TB的总体合并患病率为10.78%（95%CI：4.74 - 16.83%）。在埃塞俄比亚，抗结核药物耐药情况普遍存在。本综述中估计的INH和RIF单耐药率的合并患病率显著高于既往报告。此外，新诊断病例中的MDR-TB情况仍然严重。因此，早期发现结核病病例、进行耐药性检测、适当及时的治疗以及对结核病患者的认真随访都有助于改善DR-TB的管理和预防。除此之外，我们敦促该国实施一个强大的、基于实验室的常规耐药监测系统。
