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The extent to which drug-resistant (DR) Mycobacterium tuberculosis strains cause infection and progression to tuberculosis (TB) disease in comparison to drug-susceptible (DS) strains is unknown. Studies in guinea pigs and in vitro experiments have suggested a reduced fitness of organisms that harbour mutations that confer drug resistance [1,2]; it was therefore believed that transmitted drug resistance was a rare event. However, more recent work using molecular typing has shown transmission events occurring in the context of DR-TB [3]. Understanding the risk of transmission, infection and progression to disease in the context of DR-TB is important to guide control measures and help predict the evolution and magnitude of the multidrug-resistant (MDR)-TB epidemic. Hence, we performed a systematic review and meta-analysis to assess whether M. tuberculosis transmission and progression to TB disease (risk/rate of M. tuberculosis infection in all contacts, risk/rate of TB disease in all contacts and risk/rate of TB disease in infected contacts) differ between DR-and DS-TB.The M. tuberculosis infection was the outcome in five studies [5,[7][8][9][10]. The pooled relative risk of M. tuberculosis infection defined by positive TST using a fixed or random effects model was 1.24 (95% CI 1.08-1.42 fixed, 95% CI 0.98-1.44 random) comparing contacts of index cases with MDR-TB and DS-TB. Heterogeneity was high with an I 2 of 75%.@ERSpublications No evidence that drug-resistant TB results in fewer infections or cases in contacts than drugsusceptible TB http://ow.ly/dgez30f87dr Cite this article as: Kodama C, Lange B, Olaru ID, et al. Mycobacterium tuberculosis transmission from patients with drug-resistant compared to drug-susceptible TB: a systematic review and meta-analysis. Eur Respir J 2017; 50: 1701044 [https://doi.

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