Background
Methods
Search strategy
Definitions, data extraction, and analysis
Eligibility
Statistical analysis
Results
Summary of literature search
Summary of key study characteristics
S. No | Study (Citation) | City | Study Year | Patient population | MTB isolates total (n) | DR-TBa (%) | Mono-drug resistance (%) | MDR-TB (%) | Pre-XDRe (%) | XDRf (%) | DST method | Ref population | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
H | R | E | S | Z | Overallb
| Previously treatedc (%) | Newly diagnosed casesd (%) | Total | FQ | Inj | ||||||||||
NORTH INDIA | ||||||||||||||||||||
1 | Malhotra B et al., 2002 [50] | Jaipur | 1997–1999 | Combined PTB patients | 122 | 36.1 | 13.1 | 3.3 | 17.2 | 24.4 | 4.6 | LJ | Patients attending medical college | |||||||
2 | Sharma S K et al.(a)., 2009 [51] | Delhi | 1997–2003 | Prev. treated PTB patients | 211 | 2.4 | LJ | Tertiary hospital | ||||||||||||
3 | Rosha D & Kataria V K, 2001 [52] | Ranchi | 1999–2000 | Prev. treated PTB patients | 667 | 24.1 | 2.3 | 4.2 | 2.1 | 1.5 | 3.2 | LJ | Tertiary hospital (Armed forces) | |||||||
4 | Rai S P et al., 2007 [27] | Ranchi | 2001–2004 | Newly diagnosed PTB patients | 769 | 18.0 | 0.4 | 1.4 | 1.7 | 0.4 | 3.0 | 1.6 | 1.6 | LJ | Tertiary hospital (Armed forces) | |||||
5 | Jain A et al. (a), 2008 [53] | Lucknow | 2000–2002 | Combined PTB patients | 353 | 37.4 | 2.0 | 0.3 | 0.6 | 6.0 | 19.3 | 29.0 | 11.0 | LJ | Tertiary hospital | |||||
6 | Jain A et al. (b), 2008 [54] | Lucknow | 2002–2004 | Combined PTB patients | 686 | 38.2 | 29.7 | 20.7 | 17.8 | 27.7 | 19.8 | 25.5 | 13.2 | LJ | Primary, Secondary and Tertiary healthcare | |||||
7 | Rawat J et al., 2009 [55] | Dehradun | 2002–2006 | Prev. treated PTB patients | 180 | 62.8 | 5.00 | 57.2 | 57.2 | LJ | Tertiary hospital | |||||||||
8 | Datta B S et al., 2009 [56] | Kashmir | 2003–2007 | Newly diagnosed PTB patients | 910 | 5.7 | 0.9 | MGIT 960 | Primary, Secondary and Tertiary healthcare | |||||||||||
9 | Mathuria J P et al. (1), 2013 [38] | Sawai Madhopur | 2004–2007 | Combined PTB patients | 48 | 22.92 | 4.17 | 2.08 | 14.58 | 66.67 | 7.14 | LJ | District TB center | |||||||
Mathuria J P et al. (2), 2013 [38] | Buxar | 2004–2007 | Combined PTB patients | 24 | 54.17 | 0.00 | 4.17 | 37.50 | 43.75 | 25.00 | LJ | District TB center | ||||||||
10 | Sharma S K et al. (b), 2011 [18] | Delhi | 2005–2008 | Prev. treated PTB patients | 196 | 0.00 | 1.53 | 20.41 | 20.41 | LJ | Primary and tertiary healthcare | |||||||||
11 | Hanif M et al., 2009 [17] | Delhi | 2006 | Prev. treated PTB patients | 2880 | 52.01 | 4.69 | 47.12 | 3.72 | 13.99 | 47.12 | 47.12 | LJ | TB referral center | ||||||
12 | Magee M J et al., 2012 [57] | Delhi | 2006 | Combined PTB patients | 53 | 47.17 | 7.55 | 1.89 | 5.66 | 3.77 | 13.21 | LJ, MGIT 960 | HIV outpatient clinics (private) | |||||||
13 | Angrup A et al., 2011 [58] | Delhi | 2006–2007 | Combined PTB patients | 67 | 1.5 | 3.0 | 11.9 | 10.5 | LJ | Patients from DOTS center and private clinics | |||||||||
14 | Sethi S et al., 2013 [59] | Chandigarh | 2006–2010 | Combined PTB patients | 219 | 26.5 | 11.0 | 3.2 | 11.9 | 17.8 | 27.6 | 9.9 | LJ, MGIT 960 | Tertiary hospitals | ||||||
15 | Myneedu V P et al. (a), 2011 [60] | Delhi | 2007–2009 | Prev. treated PTB patients | 223 | 8.1 | 20.2 | LJ | Tertiary hospital | |||||||||||
16 | Mishra J K et al., 2009 [61] | Varanasi | 2007–2009 | Combined PTB patients | 51 | 21.6 | 26.5 | 11.8 | Not specified | Tertiary hospital | ||||||||||
17 | Porwal C et al., 2013 [28] | Delhi | 2007–2010 | Prev. treated PTB patients | 609 | 79.3 | 79.3 | 8.7 | 67.9 | 32.1 | 3.0 | MGIT 960 | Tertiary hospital | |||||||
18 | Sharma S K et al. (c), 2011 [62] | Delhi | 2008–2009 | Newly diagnosed PTB patients | 177 | 1.7 | 1.1 | 1.1 | LJ | Primary healthcare | ||||||||||
19 | Yadav R et al., 2013 [63] | Chandigarh | 2008–2010 | Combined PTB patients | 171 | 48.5 | 5.9 | 1.2 | 4.7 | 14.0 | 17.0 | 33.3 | 5.9 | LJ | Tertiary hospital | |||||
20 | Gupta A et al. (a), 2011 [64] | Varanasi | 2008–2010 | Combined PTB patients | 288 | 57.6 | 35.8 | LJ | Tertiary hospital | |||||||||||
21 | Sagar T et al., 2013 [65] | Delhi | 2009–2010 | Combined PTB patients | 36 | 5.6 | 2.8 | 2.8 | LJ | Tertiary hospital | ||||||||||
22 | Singh N et al., 2014 [66] | Delhi | 2009–2012 | Prev. treated PTB patients | 353 | 67.71 | 67.71 | Not specified | RNTCP district centers | |||||||||||
23 | Khanna A et al., 2010 [67] | Delhi | 2010 | Combined PTB patients | 194 | 53.6 | 3.1 | MGIT 960 | Referral cases from diagnostic center | |||||||||||
24 | Maurya A K et al., 2013 [45] | Lucknow | 2011–2012 | Combined PTB patients | 125 | 64.8 | 36.0 | BacT/ALERT and Geno-Type® MTBDR plus assay | Tertiary hospitals | |||||||||||
25 | Myneedu V P et al. (b), 2015 [68] | Lucknow | 2011–2012 | New PTB patients | 340 | 23.2 | 7.1 | 0.9 | 5.3 | 5.3 | 0.3 | LJ | District DOTS center | |||||||
26 | Singhal R et al. (b), 2015 [69] | Delhi | 2011–2012 | Prev. treated PTB patients | 2038 | 29.8 | 7.3 | 4.6 | 18.0 | 18.0 | Geno-Type® MTBDR plus assay | National Reference laboratory | ||||||||
27 | Jain A et al. (c), 2012 [29] | Lucknow | 2012 | Prev treated PTB patients | 361 | 36.0 | 17.7 | 0.6 | 1.1 | 5.0 | 36.0 | 36.0 | 15.2 | 65.5 | 34.6 | 3.1 | LJ | Tertiary care center | ||
28 | Jain A et al. (d), 2014 [16] | Lucknow, whole UP | 2009–2012 | Prev. treated PTB patients | 2496 | 54.4 | 7.8 | 0.9 | 1.6 | 5.5 | 27.8 | 27.8 | LJ | Tertiary care center | ||||||
29 | Kumar P et al., 2015 [20] | Punjab | 2012–2013 | Combined PTB patients | 545 | 53.2 | 9.4 | 18.0 | 25.9 | Gento-type MTB DRP plus assay | Tertiary care center | |||||||||
30 | Gupta H et al., 2013 [70] | Lucknow | 2010–2011 | New PTB patients | 169 | 21.3 | 18.3 | 4.7 | 10.6 | 10.1 | 4.7 | 4.7 | LJ | DOTS center | ||||||
31 | Prajapati S et al., 2016 [71] | Delhi | 2010–2011 | New PTB patients | 127 | 20.47 | 3.15 | 0.79 | 1.6 | 3.1 | 3.9 | 3.9 | MGIT 960 | AIMS, Children hospital | ||||||
32 | Gupta A et al. (b), 2015 [72] | Varanasi | 2015 | Combined PTB patients | 354 | 29.4 | LJ | Tertiary hospital | ||||||||||||
SOUTH INDIA | ||||||||||||||||||||
33 | Vasanthakumari R & Jagannath K, 1997 [73] | Chennai | 1997 | Prev. treated PTB patients | 162 | 63.0 | 20.4 | 20.4 | LJ, DST, MIC | Tertiary hospital | ||||||||||
34 | Paramasivan C N et al. (a), 2000 [74] | Tamil Nadu | 1997 | Combined PTB patients | 400 | 20.0 | 7.8 | 0.5 | 0.5 | 1.8 | 4.3 | 1.0 | 81.3 | LJ | Reference laboratories across the state | |||||
35 | Subhash H S et al., 2003 [75] | Vellore | 1997–1999 | Combined PTB patients | 291 | 54.0 | Not specified | Tertiary hospital | ||||||||||||
36 | Deivanayagam C N et al., 2002 [76] | Chennai | 1997–2000 | Prev. treated PTB patients | 618 | 80.1 | 66.3 | 55.5 | 46.4 | 35.6 | 54.9 | 54.9 | LJ | Tertiary hospital | ||||||
37 | Vijay S et al., 2004 [40] | Bangalore | 1999 | Newly diagnosed PTB patients | 271 | 27.7 | 3.7 | 0.4 | 0.4 | 13.3 | 2.2 | 2.2 | LJ | District TB Centre | ||||||
38 | Paramasivan C N et al. (b), 2002 [77] | North Arcot; Raichur | 1999 | Combined PTB patients | 587 | 27.8 | 6.1 | 0.2 | 3.2 | 6.3 | 81.5 | 2.7 | LJ | District TB Centers | ||||||
39 | Ravindran C et al., 2006 [78] | North Kerala | 1999–2000 | Newly diagnosed PTB patients | 45 | 17.8 | 4.4 | 8.9 | 8.9 | LJ | Outpatient clinics | |||||||||
40 | Velayutham B R et al., 2014 [79] | Tiruvallur | 1999–2004 | Combined PTB patients | 2408 | 20.7 | 15.7 | 3.8 | 10.1 | 3.5 | 10.6 | 1.5 | LJ | District TB Center | ||||||
41 | TRC_ICMR, 2001 [80] | Chennai | 2001 | Prev. treated PTB patients | 1817 | 21.0 | 9.4 | 0.2 | 4.0 | 5.3 | 5.3 | LJ | TB research center | |||||||
42 | Anuradha B et al., 2006 [81] | Hyderabad | 2001–2003 | Combined PTB patients | 909 | 7.0 | 2.4 | 1.0 | 0.3 | 0.9 | 1.5 | 5.6 | 0.4 | LJ | Tertiary hospital | |||||
43 | Paramasivan C N et al. (c), 2010 [31] | Chennai, across India | 2001–2004 | Prev. treated PTB patients | 2816 | 74.9 | 5.6 | 0.6 | 0.04 | 2.0 | 53.2 | 53.2 | 5.9 | 65.3 | 34.7 | 2.5 | LJ | TB research center | ||
44 | Joseph M R et al., 2007 [39] | Eranakulam | 2003 | Newly diagnosed PTB patients | 305 | 27.9 | 2.6 | 1.0 | 17.4 | 2.0 | 2.0 | Not specified | Designated microscopy centers | |||||||
45 | James P et al., 2011 [82] | Vellore | 2003–2007 | Prev. treated PTB patients | 177 | 72.9 | 5.7 | 2.8 | 58.2 | 58.2 | Not specified | Tertiary hospital | ||||||||
46 | Rajasekaran S et al., 2009 [32] | Chennai | 2004–2007 | Combined PTB patients | 2927 | 56.4 | 33.9 | 1.6 | Tertiary hospital | |||||||||||
47 | Nagaraja C et al., 2012 [83] | Bangalore | 2005–2010 | Combined PTB patients | 309 | 72.5 | LJ | Tertiary hospital | ||||||||||||
48 | Therese K L et al. (a), 2012 [84] | Chennai | 2007–2009 | Combined PTB patients | 9 | 55.6 | 11.1 | 22.2 | 22.2 | BACT-EC | Tertiary hospital | |||||||||
49 | Duraisamy K et al., 2014 [85] | Kerala | 2009–2010 | Prev. treated PTB patients | 1207 | 14.8 | 14.8 | LJ | Records from state RNTCP | |||||||||||
50 | Bhat S et al., 2010 [86] | Mangalore | 2010 | Newly diagnosed PTB patients | 50 | 82.0 | 10.0 | 6.0 | 6.0 | 32.0 | 4.0 | 4.0 | LJ | Tertiary hospital | ||||||
51 | Kandi S et al., 2013 [87] | Hyderabad | 2010–2011 | Prev. treated PTB patients | 84 | 50.0 | 13.1 | 2.4 | 1.2 | 33.3 | 33.3 | LJ | Tertiary hospital | |||||||
52 | Therese K L et al. (b), 2012 [88] | Chennai | 2011 | Combined PTB patients | 166 | 45.2 | 2.4 | 0.6 | 3.6 | 12.1 | 6.6 | BACTEC MicroMGIT | Tertiary hospital | |||||||
53 | Selvakumar N et al., 2015 [26] | Tamil Nadu | 2011–2012 | Combined PTB patients | 1934 | 26.6 | 9.6 | 1.0 | 6.00 | 13.2 | 1.8 | 1.7 | 93.9 | 6.1 | 0.2 | LJ | Designated microscopy centers | |||
54 | Gaude G S et al., 2014 [19] | Belgaum | 2011–2012 | Combined PTB patients | 66 | 69.7 | 10.6 | 3.0 | 36.4 | LJ | Tertiary hospital | |||||||||
55 | Thirumurugan R et al., 2015 [89] | Puducherry | 2011–2013 | Combined PTB patients | 127 | 70.9 | 16.5 | 54.3 | LJ | Outpatient clinics | ||||||||||
56 | Udaykumar A J et al.,2014 [90] | Bangalore | 2014 | Combined PTB patients | 61 | 32.8 | 14.8 | LJ | Tertiary hospital | |||||||||||
57 | Ranganath R et al., 2013 [91] | Mysore | 2011–2012 | Prev. treated PTB patients | 125 | 57.6 | 12.0 | 8.0 | 3.2 | 1.6 | 25.6 | 25.6 | MB/BacT system | Tertiary hospital | ||||||
EAST INDIA | ||||||||||||||||||||
58 | Mahadev B et al., (1), 2005 [92] | Hoogli,WB | 2000–2001 | Newly diagnosed PTB patients | 263 | 16.7 | 2.3 | 6.5 | 3.0 | 3.0 | LJ | Designated microscopy centers | ||||||||
Mahadev B et al. (2), 2005 [92] | Mayurbhanj, Orissa | 2000–2001 | Newly diagnosed PTB patients | 282 | 5.3 | 1.1 | 2.9 | 0.7 | 0.7 | LJ | Designated microscopy centers | |||||||||
59 | Chakraborty N et al., 2010 [93] | Kolkata | 2007–2008 | Combined PTB patients | 120 | 35.8 | 4.2 | 4.2 | 1.7 | 5.0 | 15.0 | 3.3 | LJ | Tertiary hospital | ||||||
60 | Lahiri S et al., 2015 [94] | Kolkata | 2011–2012 | Combined PTB patients | 917 | 96.3 | 1.3 | 4.7 | 0.2 | 0.8 | 80.8 | LJ | State Intermediate reference laboratories | |||||||
61 | Singhal R et al. (a), 2014 [24] | North Eastern states | 2012 | Prev. treated PTB patients | 339 | 8.6 | 8.3 | 53.4 | Geno-Type® MTBDRplus assay | Designated microscopy centers | ||||||||||
WEST INDIA | ||||||||||||||||||||
62 | Chand K et al. (a), 2000 [95] | Pune | 1995–1998 | Combined PTB patients | 1120 | 17.1 | 1.3 | 2.6 | 0.1 | 4.6 | 0.4 | 3.0 | LJ | Tertiary hospital (Armed Forces) | ||||||
63 | Shah A R et al., 2002 [96] | Ahemdabad | 2000–2001 | Prev. treated PTB patients | 822 | 58.6 | 7.5 | 1.0 | 0.5 | 1.5 | 9.3 | 9.3 | LJ | DOTS center | ||||||
64 | Chand K et al. (b), 2006 [97] | Pune | 2000–2003 | Combined PTB patients | 172 | 12.8 | 1.7 | 0.6 | 0.6 | 3.5 | 0.6 | 2.9 | LJ | Tertiary hospital (Armed forces) | ||||||
65 | Pereira M et al., 2005 [98] | Pune | 2000–2004 | Newly diagnosed PTB patients | 70 | 18.6 | 10.0 | 4.3 | 4.3 | 5.7 | 5.7 | BACTEC MGIT 960 | Tertiary hospital | |||||||
66 | Almeida D et al., 2003 [21] | Mumbai | 2003 | Combined PTB patients | 300 | 48.7 | 3.0 | 1.3 | 5.7 | 26.7 | 48.0 | 11.4 | LJ | Tertiary care center | ||||||
67 | Menon S et al., 2012 [42] | Mumbai | 2005–2009 | Combined PTB patients | 673 | 85.9 | 2.4 | 5.9 | 5.8 | 47.6 | DST not specified | Tertiary care center | ||||||||
68 | D’souza D T et al., 2009 [23] | Mumbai | 2004–2007 | Combined PTB patients | 724 | 70.4 | 9.7 | 1.0 | 0.1 | 29.3 | 41.1 | 23.7 | Buddemeyer technique | Cases from district TB registers. | ||||||
69 | Ramachandran R et al., 2009 [99] | Gujarat | 2005–2006 | Combined PTB patients | 2618 | 31.3 | 7.9 | 0.5 | 0.1 | 9.3 | 8.4 | 17.4 | 2.4 | 0.3 | LJ | Designated microscopy centers | ||||
70 | Dalal A et al., 2015 [100] | Mumbai | 2005–2013 | Prev. treated PTB patients | 340 | 29.4 | 29.4 | 29.4 | MGIT 960 | Private hospitals | ||||||||||
71 | Pradhan N et al., 2013 [101] | Pune | 2008–2010 | Prev. treated PTB patients | 249 | 53.4 | 53.4 | 53.4 | 10.0 | 52.0 | 48.0 | 4.8 | LJ | Tertiary care center | ||||||
72 | Jain S K et al., 2013 [15] | Pune | 2010–2012 | Newly diagnosed PTB patients | 3 | 66.7 | 33.3 | 33.3 | LJ, MGIT-960 | Tertiary care center | ||||||||||
73 | Vadwai V et al., 2011 [102] | Mumbai | 2011 | Combined PTB patients | 250 | 77.6 | 4.0 | 73.6 | 77.2 | 68.3 | MGIT | Tertiary care center | ||||||||
CENTRAL INDIA | ||||||||||||||||||||
74 | Hemvani N et al., 2001 [30] | Indore | 1987–1996 | Combined PTB patients | 1426 | 88.0 | 8.1 | LJ | Tertiary care center | |||||||||||
75 | Bhat J et al. 2015 [25] | Gwalior, Shivpuri | 2012–2013 | Combined PTB patients | 475 | 26.95 | 5.05 | 0.8 | 0.6 | 11.4 | 4.0 | 3.0 | 1.1 | LJ | Vulnerable Tribal Group |
Subgroup analysis (decade and region-wise) for the prevalence of DR-TB and MDR-TB
Drug resistance | n | Prevalence estimate (95% CI) | Heterogeneity test (I2) |
---|---|---|---|
1995 to 2015 | |||
Any drug-resistance | 61 | 42.6% (37.2; 48.0) | 14.4 |
Multidrug resistance | 73 | 23.3% (20.5; 26.1) | 69.2 |
Previously treated | 37 | 33.7% (27.9; 39.5) | 29.0 |
Newly diagnosed | 30 | 4.8% (3.7; 5.9) | 79.3 |
Mono-drug resistance | |||
Isoniazid | 53 | 7.2% (5.9; 8.4) | 72.5 |
Streptomycin | 40 | 6.7% (5.4; 8.0) | 67.4 |
Rifampicin | 42 | 4.6% (3.8; 5.5) | 91.3 |
Ethambutol | 31 | 1.6% (1.2; 2.0) | 92.0 |
Decade 1: 1995 to 2005 | |||
Any drug-resistance | 25 | 37.7% (29.0; 46.4) | 10.5 |
Multidrug resistance | 24 | 14.9% (11.0; 18.7) | 68.4 |
Previously treated | 13 | 29.8% (20.7; 39.0) | 45.0 |
Newly diagnosed | 13 | 4.1% (2.7; 5.6) | 70.2 |
Mono-drug resistance | |||
Isoniazid | 21 | 8.6% (6.2; 10.9) | 83.7 |
Streptomycin | 18 | 6.7% (5.0; 8.5) | 81.1 |
Rifampicin | 15 | 3.6% (2.5; 4.7) | 94.7 |
Ethambutol | 13 | 1.9% (1.2; 2.6) | 96.1 |
Decade 2: 2006 to 2015 | |||
Any drug-resistance | 36 | 46.1% (39.0; 53.2) | 9.1 |
Multidrug resistance | 49 | 27.9% (23.8; 32.1) | 57.1 |
Previously treated | 24 | 35.8% (29.2; 42.4) | 36.3 |
Newly diagnosed | 17 | 5.6% (3.8; 7.4) | 82.1 |
Mono-drug resistance | |||
Streptomycin | 22 | 6.8% (4.8; 8.8) | 28.7 |
Isoniazid | 32 | 6.2% (5.0; 7.5) | 24.9 |
Rifampicin | 27 | 5.1% (3.7; 6.6) | 84.3 |
Ethambutol | 18 | 1.7% (1.0; 2.3) | 45.2 |