Risk factors for multidrug-resistant tuberculosis: A worldwide systematic review and meta-analysis

Abstract

Background Since multidrug-resistant tuberculosis (MDR-TB) is a significant public health problem worldwide, identifying associated risk factors is critical for developing appropriate control strategies. Methods A systematic review and meta-analysis was conducted for identifying factors independently predicting MDR-TB. The random-effects model was used to determine pooled odds ratios (ORs) and respective 95% confidence intervals (CIs) for the related factors. Results Of the 2301 retrieved reports, 28 studies were analyzed, assessing 3152 MDR-TB and 52715 DS-TB cases. Totally 22 related factors were analyzed. The pooled ORs were 1.478 (95%CI 1.077–2.028) for positive sputum AFB smear, 1.716 (95%CI 1.149–2.564) for lung cavity, 6.078 (95%CI 2.903–12.725) for previous TB disease and 5.427 (95%CI 3.469–8.490) for a history of anti-TB therapy. All Z test p values were below 0.05, indicating these parameters were significantly associated with MDR-TB. Conclusions Positive sputum AFB smear, lung cavity, previously diagnosed TB and a history of anti-TB therapy are significant risk factors for MDR-TB, which are independent of the clinical setting worldwide. Increased attention should be paid to cases with such parameters to achieve more effective TB control and avoid MDR-TB through the development of a global policy.

Pharmacological Management of Pulmonary Tuberculosis: A Century of Expert Opinions in Cecil Textbook of Medicine

“…A recent worldwide systematic review and meta-analysis evaluated data from 28 studies and evaluated 3152 patients infected with M. tuberculosis resistant to both INH and RIH and a control group of 52,715 with drug-sensitive tuberculosis. 38 Among the 22 factors analyzed, only 4 were significantly associated with MDR-TB, previous history of tuberculosis (odds ratio 6.1), previous antituberculous therapy (odds ratio 5.4), sputum positive for acid-fast bacilli (odds ratio 1.7), and lung cavity visible on radiograph (odds ratio 1.5). Factors not associated with MDR-TB included age, history of incarceration, alcohol abuse, smoking, and comorbid conditions (chronic obstructive lung disease, HIV infection, and diabetes mellitus).…”

“…The high bacterial load suggested by the positive sputum smears discovered in a patient with a lung cavity should raise a red flag indicating that oral or intravenous drug therapy may not achieve bactericidal concentrations in the affected lesions and should lead to invasive procedures for drug administration. 38…”

“…The high bacterial load suggested by the positive sputum smears discovered in a patient with a lung cavity should raise a red flag indicating that oral or intravenous drug therapy may not achieve bactericidal concentrations in the affected lesions and should lead to invasive procedures for drug administration. 38 Conceptual and practical advances have been continuously pursued in the struggle against drug resistant tuberculosis. The emphasis is on shorter regimens that will hopefully reduce the mycobacterial population and limit mutagenesis and metabolic processes that enable drug tolerance.…”

Genotypic Distribution and the Epidemiology of Multidrug Resistant Tuberculosis in Upper Northern Thailand

“…A worldwide systematic review and meta-analyses reported that AFB smear positivity, lung cavity, a history of TB disease and a history of anti-TB treatment were the risk factors associated with MDR-TB [ 39 ]. However, the multivariate analysis revealed that other parameters, such as sex, age, residential area, education, marital status, occupation, diabetes mellitus, and HIV infection could not be used as independent predictors for MDR-TB [ 41 ].…”

Current Approaches to Control of Isoniazid-Resistant Tuberculosis

“…In MTB, drug resistance develops through spontaneous genetic mutations. The development of acquired drug resistance usually occurs when there is a large bacterial population, such as in pulmonary cavities (2) or when an inadequate drug combination or dosages of the first-line drugs (FLDs) has been prescribed (3,4). Rarely, malabsorption of anti-TB drugs may account for acquired resistance (5).…”