Prevalence of drug resistance-conferring mutations associated with isoniazid- and rifampicin-resistant Mycobacterium tuberculosis in Ethiopia: a systematic review and meta-analysis

Objectives Globally, tuberculosis (TB) incidence and mortality are declining; however, low detection of drug-resistant disease threatens to reverse current progress toward global TB control. Multiple, rapid molecular diagnostic tests have recently been developed to detect genetic mutations in Mycobacterium tuberculosis (Mtb) known to confer anti-TB drug resistance. Their utility, though, depends on the frequency and distribution of the resistance-associated mutations in the pathogen population. Therefore, this review aimed to assess the prevalence of the gene mutations associated with rifampicin (RIF) and isoniazid (INH) resistant Mtb in Ethiopia. Methods Using PRISMA guidelines, we searched the literature on PubMed/MEDLINE, Web of Science, Scopus, and Cochrane library databases. Data analysis was conducted in STATA 11. Results In total, 909 (95.8%) of 949 INH resistant Mtb isolates had detectable gene mutations: 95.8% in katG315 and 5.9% in the inhA-promoter region. The meta-analysis resulting an estimated prevalence of katGMUT1(S315T1) was 89.2% (95%CI:81.94-96.43%), while a pooled prevalence of inhAMUT1 (C15T) was 77.5% (95%CI:57.84-97.13%). Besides, 769 (90.8%) of 847 RIF resistant strains had detectable rpoB gene mutations, and the meta-analysis resulting in a pooled prevalence of rpoBMUT3 (S531L) was 74.2% (95%CI: 66.39-82.00%). Conclusions RIF-resistant Mtb isolates were spread widely, particularly those harboring S531L mutations. Similarly, INH-resistant Mtb strains with S315T1 and C15T mutations were common. Tracking S531L, S315T1, and C15T mutations among RIF and INH resistant isolates, respectively, would be diagnostically and epidemiologically valuable. Rapid diagnosis of RIF and INH-resistant Mtb in TB patients would expedite alteration of treatment regimens, and proper timely infection control interventions could reduce the risk of progression and transmission of multidrug-resistant TB (MDR-TB).