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Is rifampin resistance a reliable predictive marker of multidrug-resistant tuberculosis in China: A meta-analysis of findings

  • Author Footnotes
    1 These authors contributed equally to the work.
    Zhengwei Liu
    Footnotes
    1 These authors contributed equally to the work.
    Affiliations
    The Institute of TB Control, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399, Binsheng road, Binjiang District, Hangzhou 310005, China
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  • Author Footnotes
    1 These authors contributed equally to the work.
    Huali Dong
    Footnotes
    1 These authors contributed equally to the work.
    Affiliations
    Department of Clinical Laboratory, Zhejiang Xiao Shan Hospital, Hangzhou, China
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  • BeiBei Wu
    Affiliations
    The Institute of TB Control, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399, Binsheng road, Binjiang District, Hangzhou 310005, China
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  • Mingwu Zhang
    Affiliations
    The Institute of TB Control, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399, Binsheng road, Binjiang District, Hangzhou 310005, China
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  • Yelei Zhu
    Affiliations
    The Institute of TB Control, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399, Binsheng road, Binjiang District, Hangzhou 310005, China
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  • Yu Pang
    Correspondence
    Corresponding authors.
    Affiliations
    National Clinical Laboratory on Tuberculosis, Beijing Key laboratory on Drug-resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, No. 9, Beiguan Street, Tongzhou District, Beijing 101149, China
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  • Xiaomeng Wang
    Correspondence
    Corresponding authors.
    Affiliations
    The Institute of TB Control, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399, Binsheng road, Binjiang District, Hangzhou 310005, China
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  • Author Footnotes
    1 These authors contributed equally to the work.
Published:August 07, 2019DOI:https://doi.org/10.1016/j.jinf.2019.08.004

      Highlights

      • Only 77% of RR-TB cases were MDR-TB; thus RR-TB cannot predict INH resistance in China.
      • Greater MDR-TB prevalence was seen in previously treated versus new RR-TB cases.
      • The prevalence of RR-TB exhibited great diversity across regions in China.

      Summary

      Objectives

      Systematic review of multidrug-resistant tuberculosis (MDR-TB) prevalence among rifampicin (RIF)-resistant tuberculosis (RR-TB) patients in 34 provinces of China was conducted to correlate RIF resistance with concurrent isoniazid (INH) resistance.

      Methods

      Database searches (PubMed, Embase, China National Knowledge Infrastructure, Chinese Scientific Journal, Wanfang), identified drug resistance surveillance studies conducted between January 1, 2000 and June 30, 2018. Of 1554 records, random-effects meta-analysis of 34 studies of adequate methodological quality yielded 108,366 TB cases for MDR-TB prevalence analysis of RR-TB cases.

      Results

      MDR-TB prevalence among RR-TB cases varied from 57% (Xinjiang; 95% CI 47%, 67%) to 95% (Taiwan; 95% CI 92%, 98%), for a pooled national rate of 77% (95% CI 75%, 80%). Subgroup and meta-regression analyses revealed greater MDR-TB prevalence in previously treated versus new RR-TB cases (P < 0.001), with no significant differences of regional initial drug resistance rates or sampling methods. Regional MDR-TB prevalence among RR-TB cases was lowest (69%) in the Northeast Region (95% CI 65%, 73%) and highest (90%) in Hong Kong, Macao and Taiwan (95% CI 81%, 98%).

      Conclusions

      In China, ∼77% of RR-TB cases are MDR-TB. Thus, RIF resistance cannot effectively predict MDR-TB. Highly variable RR-TB prevalence across China warrants improved TB management.

      Keywords

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