https://doi.org/10.4081/monaldi.2024.2844
Multidrug-resistant tuberculosis in Iran: a multicenter study
Submitted: November 7, 2023
Accepted: December 28, 2023
Published: January 12, 2024
Accepted: December 28, 2023
Abstract Views: 532
PDF_EARLY VIEW: 237
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
The worldwide incidence of multi-drug-resistant tuberculosis (MDR-TB) is rapidly increasing, and it has emerged as a pressing public health issue in Iran. Nevertheless, there is a scarcity of up-to-date research on the prevalence of MDR-TB in individuals with pulmonary TB in the country. In this cross-sectional study, we gathered a total of 1216 respiratory samples, each corresponding to a unique patient, from five distinct regional TB laboratories in Iran. We identified clinical isolates as Mycobacterium tuberculosis using the IS6110-based PCR assay and Xpert MTB/RIF. Drug susceptibility testing (DST) was conducted using the conventional proportion method. Out of the collected specimens, 448 tested positive for M. tuberculosis. Among these isolates, 445 (99.4%) exhibited susceptibility to the tested drugs, while 3 (0.6%) were found to be MDR. The findings from this recent study indicate that the prevalence of MDR in Iran stands at 0.6%. The absence of recently approved treatment protocols in various regions of Iran, along with inadequately equipped laboratories lacking DST capabilities, could contribute significantly to the rise in TB/MDR-TB prevalence in Iran. Therefore, the implementation of enhanced treatment management strategies and the adoption of innovative technologies are essential steps towards improving the current situation.
Millard J, Ugarte-Gil C, Moore DA. Multidrug resistant tuberculosis. BMJ 2015;350:h882.
DOI: https://doi.org/10.1136/bmj.h882
Saderi L, Cabibbe AM, Puci M, et al. A systematic review of the costs of diagnosis for multidrug-resistant/extensively drug-resistant TB in different settings. Int J Tuberc Lung Dis 2023;27:348-56.
DOI: https://doi.org/10.5588/ijtld.22.0657
Maier C, Chesov D, Schaub D, et al. Long-term treatment outcomes in patients with multidrug-resistant tuberculosis. Clin Microbiol Infect 2023;29:751-7.
DOI: https://doi.org/10.1016/j.cmi.2023.02.013
Chakaya J, Khan M, Ntoumi F, et al. Global Tuberculosis Report 2020 - reflections on the global TB burden, treatment and prevention efforts. Int J Infect Dis 2021;113:S7-S12.
DOI: https://doi.org/10.1016/j.ijid.2021.02.107
Nasiri MJ, Dabiri H, Darban-Sarokhalil D, et al. Prevalence of drug-resistant tuberculosis in Iran: systematic review and meta-analysis. Am J Infect Control 2014;42:1212-8.
DOI: https://doi.org/10.1016/j.ajic.2014.07.017
Bahraminia F, Zangiabadian M, Nasiri MJ, et al. Rifampicin resistance in Mycobacterium tuberculosis in Iran: a two-centre study. New Microbes New Infect 2021;42:100909.
DOI: https://doi.org/10.1016/j.nmni.2021.100909
Metanat M, Sharifi-Mood B, Shahreki SH, Dawoudi SH. Prevalence of multidrug-resistant and extensively drug-resistant tuberculosis in patients with pulmonary tuberculosis in zahedan, southeastern iran. Iran Red Crescent Med J 2012;14:53-5.
Nasiri MJ, Rezaei F, Zamani S, et al. Drug resistance pattern of Mycobacterium tuberculosis isolates from patients of five provinces of Iran. Asian Pac J Trop Med 2014;7:193-6.
DOI: https://doi.org/10.1016/S1995-7645(14)60019-5
Mohajeri P, Norozi B, Atashi S, Farahani A, et al. Anti tuberculosis drug resistance in west of Iran. J Glob infect Dis 2014;6:114-7.
DOI: https://doi.org/10.4103/0974-777X.138506
Farazi A, Sofian M, Zarrinfar N, et al. Drug resistance pattern and associated risk factors of tuberculosis patients in the central province of Iran. Caspian J Int Med 2013;4:785-9.
Atashi S, Izadi B, Jalilian S, et al. Evaluation of GeneXpert MTB/RIF for determination of rifampicin resistance among new tuberculosis cases in west and northwest Iran. New Microbes New Infect 2017;19:117-20.
DOI: https://doi.org/10.1016/j.nmni.2017.07.002
Yaacoub H, Farhat AM, Najjar-Pellet J, et al. Planning for TB elimination in Lebanon. Int J Tuberc Lung Dis 2023;27:171-4.
DOI: https://doi.org/10.5588/ijtld.22.0673
Migliori GB, Dowdy D, Denholm JT, et al. The path to tuberculosis elimination: a renewed vision. Eur Respir J 2023;61:2300499.
DOI: https://doi.org/10.1183/13993003.00499-2023
Millard J, Rimmer S, Nimmo C, O’Donnell M. Therapeutic failure and acquired bedaquiline and delamanid resistance in treatment of drug-resistant TB. Emerg Infect Dis 2023;29:1081-4.
DOI: https://doi.org/10.3201/eid2905.221716
Vanino E, Granozzi B, Akkerman OW, et al. Update of drug-resistant tuberculosis treatment guidelines: a turning point. Int J Infect Dis 2023;130:S12-S15.
DOI: https://doi.org/10.1016/j.ijid.2023.03.013
Bossù G, Autore G, Bernardi L, et al. Treatment options for children with multi-drug resistant tuberculosis. Expert Rev Clin Pharmacol 2023;16:5-15.
DOI: https://doi.org/10.1080/17512433.2023.2148653
Padmapriyadarsini C, Vohra V, Bhatnagar A, et al. Bedaquiline, delamanid, linezolid, and clofazimine for treatment of pre-extensively drug-resistant tuberculosis. Clin Infect Dis 2023;76:e938-46.
Nasiri MJ, Zangiabadian M, Arabpour E, et al. Delamanid-containing regimens and multidrug-resistant tuberculosis: a systematic review and meta-analysis. Int J Infect Dis 2022;124:S90-S103.
DOI: https://doi.org/10.1016/j.ijid.2022.02.043
Hatami H, Sotgiu G, Bostanghadiri N, et al. Bedaquiline-containing regimens and multidrug-resistant tuberculosis: a systematic review and meta-analysis. J Bras Pneumol 2022;48:e20210384.
DOI: https://doi.org/10.36416/1806-3756/e20210384
Tiberi S, Utjesanovic N, Galvin J, et al. Drug resistant TB-latest developments in epidemiology, diagnostics and management. Int J Infect Dis 2022;124:S20-5.
DOI: https://doi.org/10.1016/j.ijid.2022.03.026
Perrin C, Athersuch K, Elder G, et al. Recently developed drugs for the treatment of drug-resistant tuberculosis: a research and development case study. BMJ Glob Health 2022;7:e007490.
DOI: https://doi.org/10.1136/bmjgh-2021-007490
Umar F, Hatta M, Husain DR, et al. The effect of anti-tuberculosis drugs therapy on mRNA efflux pump gene expression of Rv1250 in Mycobacterium tuberculosis collected from tuberculosis patients. New Microbes New Infect 2019;32:100609.
DOI: https://doi.org/10.1016/j.nmni.2019.100609
Resch SC, Salomon JA, Murray M, et al. Cost-effectiveness of treating multidrug-resistant tuberculosis. PLoS Med 2006;3:e241.
DOI: https://doi.org/10.1371/journal.pmed.0030241
Tiberi S, Muñoz-Torrico M, Duarte R, et al. New drugs and perspectives for new anti-tuberculosis regimens. Pulmonology 2018;24:86-98.
DOI: https://doi.org/10.1016/j.rppnen.2017.10.009
Migliori, G.B., et al., MDR/XDR-TB management of patients and contacts: Challenges facing the new decade. The 2020 clinical update by the Global Tuberculosis Network. International Journal of Infectious Diseases, 2020. 92: p. S15-S25.
Migliori GB, Tiberi S. WHO drug-resistant TB guidelines 2022: what is new? Int J Tuberc Lung Dis 2022;26:590-1.
DOI: https://doi.org/10.5588/ijtld.22.0263
WHO. WHO consolidated guidelines on tuberculosis. Module 4: treatment-drug-resistant tuberculosis treatment, 2022 update. Available from: https://iris.who.int/bitstream/handle/10665/365308/9789240063129-eng.pdf?sequence=1.
Schön T, Miotto P, Köser CU, et al. Mycobacterium tuberculosis drug-resistance testing: challenges, recent developments and perspectives. Clin Microbiol Infect 2017;23:154-60.
DOI: https://doi.org/10.1016/j.cmi.2016.10.022
Kim SJ. Drug-susceptibility testing in tuberculosis: methods and reliability of results. Eur Respir J 2005;25:564-9.
DOI: https://doi.org/10.1183/09031936.05.00111304
Van Deun A, Wright A, Zignol M, et al. Drug susceptibility testing proficiency in the network of supranational tuberculosis reference laboratories. Int J Tuberc Lung Dis 2011;15:116-24.
Amini S, Hoffner S, Torkaman MRA, et al. Direct drug susceptibility testing of Mycobacterium tuberculosis using the proportional method: a multicenter study. J Glob Antimicrob Resist 2019;17:242-4.
DOI: https://doi.org/10.1016/j.jgar.2018.12.022
Dean AS, Auguet OT, Glaziou P, et al. 25 years of surveillance of drug-resistant tuberculosis: achievements, challenges, and way forward. Lancet Infect Dis 2022;22:e191-6.
DOI: https://doi.org/10.1016/S1473-3099(21)00808-2
Ntoumi F, Nachega JB, Aklillu E, et al. World tuberculosis day 2022: aligning COVID-19 and tuberculosis innovations to save lives and to end tuberculosis. Lancet Infect Dis 2022;22:442-4.
DOI: https://doi.org/10.1016/S1473-3099(22)00142-6
Gotham D, McKenna L, Frick M, Lessem E. Public investments in the clinical development of bedaquiline. PLoS One 2020;15:e0239118.
DOI: https://doi.org/10.1371/journal.pone.0239118
Aldridge BB, Barros-Aguirre D, Barry CE 3rd, et al. The tuberculosis drug accelerator at year 10: what have we learned? Nat Med 2021;27:1333-7.
DOI: https://doi.org/10.1038/s41591-021-01442-2
Kendall EA, Sahu S, Pai M, et al. What will it take to eliminate drug-resistant tuberculosis?. Int J Tuberc Lung Dis 2019;23:535-46.
DOI: https://doi.org/10.5588/ijtld.18.0217
Ethics Approval
The study was approved by the Ethics Committee of the Shahid Beheshti University of Medical Sciences, Tehran, Iran (IR.SBMU.MSP.REC.1400.677).How to Cite
Khelghati, Fatemeh, Fatemeh Nasirpour Seilakhori, Mehdi Goudarzi, Shima Malekloo, Amir Hashem Shahidi Bonjar, Hossein Goudarzi, and Mohammad Javad Nasiri. 2024. “Multidrug-Resistant Tuberculosis in Iran: A Multicenter Study”. Monaldi Archives for Chest Disease, January. https://doi.org/10.4081/monaldi.2024.2844.
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