Epidemiology and Risk Factors of Multidrug-Resistant Tuberculosis
Summary
Multidrug-resistant tuberculosis (MDR-TB), defined by resistance to at least isoniazid and rifampicin, poses a persistent threat to global tuberculosis control. Incidence remains highest in regions of Eastern Europe, sub-Saharan Africa and South-East Asia, with pockets of elevated prevalence in urban slums and prisons. Transmission of MDR-TB arises both through primary spread of resistant strains and secondary development during inadequate treatment. Key risk factors include prior tuberculosis treatment, coinfection with HIV, lung cavitation and high mycobacterial load indicated by positive sputum smear. Socioeconomic determinants such as poverty, overcrowding and limited access to health services exacerbate vulnerability. Surveillance has been strengthened by molecular diagnostics and whole-genome sequencing, enabling rapid detection of resistance patterns and outbreak investigation. Nevertheless, delays in diagnosis and initiation of effective second-line regimens perpetuate transmission and mortality. Integration of patient-centred adherence support, robust drug-susceptibility testing and tailored public health interventions is critical to curb the spread of MDR-TB. Emerging challenges include the rise of extensively drug-resistant strains, shortages of novel therapeutic agents and the impact of comorbidities such as diabetes. Concerted global efforts to enhance diagnostic capacity, ensure uninterrupted drug supply and address social drivers are essential to achieve durable control of MDR-TB.
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Epidemiology and Risk Factors of Multidrug-Resistant Tuberculosis publication trend
The graph below shows the total number of articles in epidemiology and risk factors of multidrug-resistant tuberculosis across all publications each year (not limited to Nature Index journals).
Technical terms
Multidrug-Resistant Tuberculosis (MDR-TB): Infection by Mycobacterium tuberculosis strains resistant to at least isoniazid and rifampicin.
Extensively Drug-Resistant Tuberculosis (XDR-TB): MDR-TB with additional resistance to any fluoroquinolone and at least one second-line injectable agent.
Drug Susceptibility Testing (DST): Laboratory assays used to determine the sensitivity of Mycobacterium tuberculosis isolates to anti-tuberculosis drugs.
Meta-Analysis: A statistical method that combines results from multiple independent studies to derive pooled estimates of effect or prevalence.
References
- Global prevalence of drug-resistant tuberculosis: a systematic review and meta-analysis. Infectious Diseases of Poverty (2023).
- Trends in and Risk Factors for Drug Resistance in Mycobacterium tuberculosis in HIV-Infected Patients. Viruses (2024).
- Risk factors for multidrug-resistant tuberculosis: A worldwide systematic review and meta-analysis. PLOS ONE (2022).
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