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The reliability of rifampicin resistance as a proxy for multidrug-resistant tuberculosis: a systematic review of studies from Iran

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Abstract

In Iran, patients showing rifampicin (RIF) resistance detected by the Xpert® MTB/RIF assay are considered as candidates for multidrug-resistant tuberculosis (MDR-TB) treatment. Despite the fact that RIF resistance has been used as a proxy for MDR-TB, little is known about the proportion of isoniazid (INH) resistance patterns in RIF-resistant TB. We systematically searched MEDLINE, Embase, and other databases up to March 2017 for studies addressing the proportion of INH resistance patterns in RIF-resistant TB in Iran. The data were pooled using a random effects model. Heterogeneity was assessed using Cochran’s Q and I2 statistics. A total of 11 articles met the eligibility criteria. Data analysis demonstrated that 33.3% of RIF-resistant isolates from new TB cases and 14.8% of RIF-resistant isolates from previously treated cases did not display resistance to INH. The relatively high proportion of INH susceptibility among isolates with RIF resistance indicated that RIF resistance may no longer predict MDR-TB in Iran. Therefore, the detection of RIF resistance by the Xpert MTB/RIF assay will require complementary detection of INH resistance by other drug susceptibility testing (DST) methods in order to establish the diagnosis of MDR-TB.

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Acknowledgments

We would like to thank the “Clinical Research Development Center of Baqiyatallah Hospital” for their kind cooperation.

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Authors and Affiliations

  1. Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    M. J. Nasiri & A. Pormohammad

  2. Department of Microbiology, School of Medicine, Golestan University of Medical Sciences, Gorgan, Iran

    S. Zamani

  3. Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

    M. M. Feizabadi

  4. Thoracic Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran

    M. M. Feizabadi

  5. Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    H. R. Aslani

  6. Department of Drug and Food Control, and Pharmaceutical Quality Assurance Research Center, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran

    M. Amin

  7. Applied Microbiology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran

    R. Halabian & A. A. Imani Fooladi

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  1. M. J. Nasiri
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  2. S. Zamani
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Corresponding author

Correspondence to A. A. Imani Fooladi.

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The manuscript is a systematic review, so ethical approval was not required for the study.

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Nasiri, M.J., Zamani, S., Pormohammad, A. et al. The reliability of rifampicin resistance as a proxy for multidrug-resistant tuberculosis: a systematic review of studies from Iran. Eur J Clin Microbiol Infect Dis 37, 9–14 (2018). https://doi.org/10.1007/s10096-017-3079-4

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  • DOI: https://doi.org/10.1007/s10096-017-3079-4

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