Global treatment outcomes of extensively drug-resistant tuberculosis in adults: A systematic review and meta-analysis

医学 肺结核 荟萃分析 梅德林 广泛耐药结核 抗药性 药品 耐药结核 内科学 耐多药结核病 重症监护医学 系统回顾 结核分枝杆菌 药理学 病理 微生物学 政治学 法学 生物
作者
Oluf Pedersen,Freja Breth Holmgaard,Mark E. Mikkelsen,Christoph Lange,Giovanni Sotgiu,Troels Lillebæk,Aase Bengaard Andersen,Christian Wejse,Victor Dahl Mathiasen
出处
期刊:Journal of Infection [Elsevier BV]
卷期号:87 (3): 177-189 被引量:1
标识
DOI:10.1016/j.jinf.2023.06.014
摘要

Historically, extensively drug-resistant tuberculosis has been notoriously difficult to treat with devasting outcomes. As we are coming to the end of an era where the 2006 extensively drug-resistant tuberculosis definitions and old treatment regimens are being replaced, we aimed to estimate the proportion of extensively drug-resistant tuberculosis patients globally who achieved successful treatment outcomes.We conducted a systematic review of PubMed/MEDLINE, Scopus, Web of Science, and Embase from January 1, 2005, through April 3, 2023. Included studies reported WHO treatment outcomes, or adaptions hereof, for pre-extensively and/or extensively drug-resistant tuberculosis patients according to the 2006 WHO definition. Eligible studies included cohorts of at least 10 adults (aged>18 years) that were not pregnant. Using a random-effects model, we calculated pooled proportions of treatment outcomes and performed sensitivity and subgroup analyses. PROSPERO registration number: CRD42022340961.Among 5056 studies reviewed, we identified 94 studies from 26 countries, involving 10,223 extensively drug-resistant tuberculosis patients. The pooled proportion of successful treatment outcomes was 44.2% (95%CI: 38.3-50.3). Sensitivity analyses consistently produced similar estimates. A slight improvement in treatment outcomes was observed after 2013. Furthermore, 25 studies reported outcomes for 3564 individuals with pre-extensively drug-resistant tuberculosis, of which 63.3% achieved successful treatment (95%CI: 43.1-72.5).Globally, the success rate of extensively drug-resistant tuberculosis treatment is 44.2%, far below the WHO's target rate of 75%. These results may serve as a reference for future studies assessing extensively drug-resistant tuberculosis treatment outcomes under the 2021 definition treated with better treatment regimens available. Comprehensive surveillance data of extensively drug-resistant tuberculosis outcomes from the whole world are desirable to monitor treatment progress.

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