Abstract
BackgroundThe spread of drug-resistant tuberculosis (TB) is one of the major public health problems in the world. Surveillance of anti-TB drug resistance is important for monitoring TB control strategies. However, the status of drug-resistant TB in China has been reported inconsistently.MethodsWe systematically reviewed published studies on drug-resistant TB in China until March 31, 2011, and quantitatively summarized prevalence and patterns of anti-TB drug resistance among new cases and previously treated cases, respectively.ResultsNinety-five eligible articles, published during 1993–2011, were included in this review. The meta-analyses showed that the prevalence of drug-resistant TB in new cases was 27.9% (95% CI, 25.6%–30.2%) (n/N = 27360/104356) and in previously treated cases was 60.3% (95% CI, 56.2%–64.2%) (n/N = 30350/45858). Furthermore, in these two study populations, the prevalence of multiple drug resistance was found to be 5.3% (95% CI, 4.4%–6.4%) (n/N = 8810/101718) and 27.4% (95% CI, 24.1%–30.9%) (n/N = 10486/44530) respectively. However, the results were found to be frequently heterogeneous (p for Q tests <0.001). The most common resistance was observed for isoniazid among both study populations. Different patterns of drug resistance were observed in the subgroup analysis with respect to geographic areas, drug susceptibility testing methods and subject enrollment time.ConclusionsResults of meta-analyses indicated a severe status of drug-resistant TB in China, which attaches an importance to strength TB prevention and control.
Highlights
The prevalence of anti-tuberculosis (TB) drug resistance, which increases the rate of treatment failure and the costs of control, is a major challenge to global public health [1,2,3]
Together with delayed diagnosis and lack or inadequacy of TB control programs, the emergence of multidrug-resistant (MDR) TB has complicated the epidemiology of TB [4,5]
In 2000, the Fourth National Epidemiological Sampling Survey of Tuberculosis estimated the prevalence of TB infection in China is as high as 44.5%, and there were around 0.5 million drug-resistant TB cases among 200 million smear positive pulmonary TB patients [9]
Summary
The prevalence of anti-tuberculosis (TB) drug resistance, which increases the rate of treatment failure and the costs of control, is a major challenge to global public health [1,2,3]. As reported, increased drug resistance rates to the first-line antiTB drugs and MDR were observed in China in the past decade [7,8]. These estimates presented high degrees of variability because the study setting were heterogeneous (i.e. population involved, geographic areas, outcome measurements, etc.). In 2000, the Fourth National Epidemiological Sampling Survey of Tuberculosis estimated the prevalence of TB infection in China is as high as 44.5%, and there were around 0.5 million drug-resistant TB cases among 200 million smear positive pulmonary TB patients [9]. The status of drugresistant TB in China has been reported inconsistently
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