title: The Prevalence of Drug-Resistant Tuberculosis in Mainland China: An Updated Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  In recent years, drug resistant tuberculosis (DR-TB) particularly the emergence of multi-drug-resistant tuberculosis (MDR-TB) has become a major public health issue. The most recent study regarding the prevalence of drug-resistant tuberculosis in mainland China was a meta-analysis published in 2011, and the subjects from the included studies were mostly enrolled before 2008, thus making it now obsolete. Current data on the national prevalence of DR-TB is needed. This review aims to provide a comprehensive and up-to-date assessment of the status of DR-TB epidemic in mainland China.
  
  
  METHODS
  A systematic review and meta-analysis of studies regarding the prevalence of drug-resistant tuberculosis in mainland China was performed. Pubmed/MEDLINE, EMBASE, the Cochrane central database, the Chinese Biomedical Literature Database and the China National Knowledge Infrastructure Database were searched for studies relevant to drug-resistant tuberculosis that were published between January 1, 2012 and May 18, 2015. Comprehensive Meta-Analysis (V2.2, Biostat) software was used to analyse the data.
  
  
  RESULTS
  A total of fifty-nine articles, published from 2012 to 2015, were included in our review. The result of this meta-analysis demonstrated that among new cases, the rate of resistance to any drug was 20.1% (18.0%-22.3%; n/N = 7203/34314) and among retreatment cases, the rate was 49.8% (46.0%-53.6%; n/N = 4155/8291). Multi-drug resistance among new and retreatment cases was 4.8% (4.0%-5.7%; n/N = 2300/42946) and 26.3% (23.1%-29.7%; n/N = 3125/11589) respectively. The results were significantly heterogeneous (p<0.001, I2 tests). Resistance to isoniazid was the most common resistance observed, and HRSE (H: isoniazid; R: rifampicin; S: streptomycin; E: ethambutol) was the most common form for MDR among both new and retreatment cases. Different drug resistance patterns were found by subgroup analysis according to geographic areas, subject enrolment time, and methods of drug susceptibility test (DST).
  
  
  CONCLUSIONS
  The prevalence of resistance to any drug evidently dropped for both new and retreatment cases, and multi-drug resistance declined among new cases but became more prevalent among retreatment cases compared to the data before 2008. Therefore, drug-resistant tuberculosis, particularly multi-drug-resistant tuberculosis among retreatment TB cases is a public health issue in China that requires a constant attention in order to prevent increase in MDR-TB cases.
authors: Department of Tuberculosis Prevention, Wuhan Tuberculosis Institution, Wuhan, Hubei, China.
authors: Qionghong
authors: Q
authors: Duan
authors: Department of Tuberculosis Prevention, Wuhan Tuberculosis Institution, Wuhan, Hubei, China.
authors: Zi
authors: Z
authors: Chen
authors: Department of Tuberculosis Prevention, Wuhan Tuberculosis Institution, Wuhan, Hubei, China.
authors: Cong
authors: C
authors: Chen
authors: Department of Tuberculosis Prevention, Wuhan Tuberculosis Institution, Wuhan, Hubei, China.
authors: Zhengbin
authors: Z
authors: Zhang
authors: Department of Tuberculosis Prevention, Wuhan Tuberculosis Institution, Wuhan, Hubei, China.
authors: Zhouqin
authors: Z
authors: Lu
authors: Department of Thyroid-Breast Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
authors: Yalong
authors: Y
authors: Yang
authors: Department of Thyroid-Breast Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
authors: Lin
authors: L
authors: Zhang
mesh_terms: D002681:China / Q000453:epidemiology; D006801:Humans; D015995:Prevalence; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology*