Resistance of Mycobacterium tuberculosis strains to Isoniazid: A systematic review and meta-analysis

Abstract

Background: Genotyping and drug susceptibility test of Mycobacterium tuberculosis (MTB) is recommended to understand the prevalence of Isoniazid resistance to facilitate early treatment initiation and controlling the spread of the resistant strain in the community. Although several primary studies reported from different parts of the world, there are few review studies that attempt to summarize the available information to support tuberculosis (TB) control program. Thus, this review aimed to determine the prevalence of isoniazid resistance MTB family and identify the high-risk WHO regions. Methods: Medline/PubMed and EMBASE databases were searched until 22 November 2022 to access all original studies that published in English. The random effects model was used to estimate pooled prevalence of isoniazid (INH) resistance. Sub-groups analyses were done to investigate sources of heterogeneity by the type of MTB genotype and WHO regions. Random effects model was used to pool the prevalence of isoniazid resistance. Publication bias was assessed by Funnel plot, Egger’s test and Begg’s test statistic. Heterogeneity across studies was measured by I2 and data was analyzed by STATA version 14. Results: The pooled prevalence of INH resistance MTB strains was 18% (95%CI: 15–22) with high heterogeneity (I2 = 97.70%). The subgroup analysis by WHO regions showed that the prevalence of INH resistance MTB was: 18% (95%CI: 14–23%) in Western pacific region, 25% (95%CI: 13–38%) in South-East Asian region, 34% (95%CI; 17– 52%) in European region, 8% (95%CI: 5–11%) in African region, 19% (95%CI: 10–27%) in region of America and 10% (95%CI: 9–12%) in Eastern Mediterranean region. Sub-group analysis by MTB genotype showed that 22% (95%CI: 18–26%) Beijing INH resistance, 19% (95%CI: 16–22%) unclassified strains, 27% (95%CI:10–54%) Ural, 15% (95%CI: 1–20%) CAS, 19% (95%CI: 14–24%) LAM, 15% (95%CI:11–19%) EAI 38% (95%CI: 24–51%), MANU, 22% (95%CI: 16–27%) T, 24% (95%CI: 18–31%) Haarlem, 7% (95%CI: 5–10%) Euro-American, and 41% (95%CI: 34–49%) Orphan. Conclusion: The INH resistance was considerable in different regions of the world. The highest prevalence was observed in European, South-East Asia and America WHO regions. Beijing family is the most prevalent of INH resistance in these regions. Intervention is required to reduce INH resistance to achieve end TB strategy.