Drug-resistant tuberculosis: a persistent global health concern

Drug-resistant tuberculosis (TB) is estimated to cause 13% of all antimicrobial resistance-attributable deaths worldwide and is driven by both ongoing resistance acquisition and person-to-person transmission. Poor outcomes are exacerbated by late diagnosis and inadequate access to effective treatmen...

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Published inNature reviews. Microbiology Vol. 22; no. 10; pp. 617 - 635
Main Authors Farhat, Maha, Cox, Helen, Ghanem, Marwan, Denkinger, Claudia M., Rodrigues, Camilla, Abd El Aziz, Mirna S., Enkh-Amgalan, Handaa, Vambe, Debrah, Ugarte-Gil, Cesar, Furin, Jennifer, Pai, Madhukar
Format Journal Article
LanguageEnglish
Published London Nature Publishing Group UK 01.10.2024
Nature Publishing Group
Subjects
631/326/107
631/326/22/1434
631/326/41/1470
631/326/41/2529
631/326/421
Antimicrobial resistance
Antitubercular Agents - pharmacology
Antitubercular Agents - therapeutic use
Biomedical and Life Sciences
Diagnosis
Disease transmission
Drug resistance
Epidemiology
Gene sequencing
Global Health
Humans
Infectious Diseases
Life Sciences
Medical Microbiology
Mental health
Microbiology
Mycobacterium tuberculosis - drug effects
Mycobacterium tuberculosis - genetics
Next-generation sequencing
Parasitology
Phenotypes
Public health
Resistance factors
Review Article
Risk factors
Risk reduction
Side effects
Stigma
Tuberculosis
Tuberculosis, Multidrug-Resistant - diagnosis
Tuberculosis, Multidrug-Resistant - drug therapy
Tuberculosis, Multidrug-Resistant - epidemiology
Virology
Online AccessGet full text
ISSN1740-1526
1740-1534
1740-1534
DOI10.1038/s41579-024-01025-1

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Abstract Drug-resistant tuberculosis (TB) is estimated to cause 13% of all antimicrobial resistance-attributable deaths worldwide and is driven by both ongoing resistance acquisition and person-to-person transmission. Poor outcomes are exacerbated by late diagnosis and inadequate access to effective treatment. Advances in rapid molecular testing have recently improved the diagnosis of TB and drug resistance. Next-generation sequencing of Mycobacterium tuberculosis has increased our understanding of genetic resistance mechanisms and can now detect mutations associated with resistance phenotypes. All-oral, shorter drug regimens that can achieve high cure rates of drug-resistant TB within 6–9 months are now available and recommended but have yet to be scaled to global clinical use. Promising regimens for the prevention of drug-resistant TB among high-risk contacts are supported by early clinical trial data but final results are pending. A person-centred approach is crucial in managing drug-resistant TB to reduce the risk of poor treatment outcomes, side effects, stigma and mental health burden associated with the diagnosis. In this Review, we describe current surveillance of drug-resistant TB and the causes, risk factors and determinants of drug resistance as well as the stigma and mental health considerations associated with it. We discuss recent advances in diagnostics and drug-susceptibility testing and outline the progress in developing better treatment and preventive therapies. In this Review, Pai and colleagues examine the global landscape of drug-resistant tuberculosis, exploring its epidemiology, causes, risk factors, stigma and associated mental health burden as well as discussing the most recent developments in diagnostics, treatment and preventive regimens.
AbstractList Drug-resistant tuberculosis (TB) is estimated to cause 13% of all antimicrobial resistance-attributable deaths worldwide and is driven by both ongoing resistance acquisition and person-to-person transmission. Poor outcomes are exacerbated by late diagnosis and inadequate access to effective treatment. Advances in rapid molecular testing have recently improved the diagnosis of TB and drug resistance. Next-generation sequencing of Mycobacterium tuberculosis has increased our understanding of genetic resistance mechanisms and can now detect mutations associated with resistance phenotypes. All-oral, shorter drug regimens that can achieve high cure rates of drug-resistant TB within 6–9 months are now available and recommended but have yet to be scaled to global clinical use. Promising regimens for the prevention of drug-resistant TB among high-risk contacts are supported by early clinical trial data but final results are pending. A person-centred approach is crucial in managing drug-resistant TB to reduce the risk of poor treatment outcomes, side effects, stigma and mental health burden associated with the diagnosis. In this Review, we describe current surveillance of drug-resistant TB and the causes, risk factors and determinants of drug resistance as well as the stigma and mental health considerations associated with it. We discuss recent advances in diagnostics and drug-susceptibility testing and outline the progress in developing better treatment and preventive therapies.In this Review, Pai and colleagues examine the global landscape of drug-resistant tuberculosis, exploring its epidemiology, causes, risk factors, stigma and associated mental health burden as well as discussing the most recent developments in diagnostics, treatment and preventive regimens.
Drug-resistant tuberculosis (TB) is estimated to cause 13% of all antimicrobial resistance-attributable deaths worldwide and is driven by both ongoing resistance acquisition and person-to-person transmission. Poor outcomes are exacerbated by late diagnosis and inadequate access to effective treatment. Advances in rapid molecular testing have recently improved the diagnosis of TB and drug resistance. Next-generation sequencing of Mycobacterium tuberculosis has increased our understanding of genetic resistance mechanisms and can now detect mutations associated with resistance phenotypes. All-oral, shorter drug regimens that can achieve high cure rates of drug-resistant TB within 6-9 months are now available and recommended but have yet to be scaled to global clinical use. Promising regimens for the prevention of drug-resistant TB among high-risk contacts are supported by early clinical trial data but final results are pending. A person-centred approach is crucial in managing drug-resistant TB to reduce the risk of poor treatment outcomes, side effects, stigma and mental health burden associated with the diagnosis. In this Review, we describe current surveillance of drug-resistant TB and the causes, risk factors and determinants of drug resistance as well as the stigma and mental health considerations associated with it. We discuss recent advances in diagnostics and drug-susceptibility testing and outline the progress in developing better treatment and preventive therapies.
Drug-resistant tuberculosis (TB) is estimated to cause 13% of all antimicrobial resistance-attributable deaths worldwide and is driven by both ongoing resistance acquisition and person-to-person transmission. Poor outcomes are exacerbated by late diagnosis and inadequate access to effective treatment. Advances in rapid molecular testing have recently improved the diagnosis of TB and drug resistance. Next-generation sequencing of Mycobacterium tuberculosis has increased our understanding of genetic resistance mechanisms and can now detect mutations associated with resistance phenotypes. All-oral, shorter drug regimens that can achieve high cure rates of drug-resistant TB within 6-9 months are now available and recommended but have yet to be scaled to global clinical use. Promising regimens for the prevention of drug-resistant TB among high-risk contacts are supported by early clinical trial data but final results are pending. A person-centred approach is crucial in managing drug-resistant TB to reduce the risk of poor treatment outcomes, side effects, stigma and mental health burden associated with the diagnosis. In this Review, we describe current surveillance of drug-resistant TB and the causes, risk factors and determinants of drug resistance as well as the stigma and mental health considerations associated with it. We discuss recent advances in diagnostics and drug-susceptibility testing and outline the progress in developing better treatment and preventive therapies.Drug-resistant tuberculosis (TB) is estimated to cause 13% of all antimicrobial resistance-attributable deaths worldwide and is driven by both ongoing resistance acquisition and person-to-person transmission. Poor outcomes are exacerbated by late diagnosis and inadequate access to effective treatment. Advances in rapid molecular testing have recently improved the diagnosis of TB and drug resistance. Next-generation sequencing of Mycobacterium tuberculosis has increased our understanding of genetic resistance mechanisms and can now detect mutations associated with resistance phenotypes. All-oral, shorter drug regimens that can achieve high cure rates of drug-resistant TB within 6-9 months are now available and recommended but have yet to be scaled to global clinical use. Promising regimens for the prevention of drug-resistant TB among high-risk contacts are supported by early clinical trial data but final results are pending. A person-centred approach is crucial in managing drug-resistant TB to reduce the risk of poor treatment outcomes, side effects, stigma and mental health burden associated with the diagnosis. In this Review, we describe current surveillance of drug-resistant TB and the causes, risk factors and determinants of drug resistance as well as the stigma and mental health considerations associated with it. We discuss recent advances in diagnostics and drug-susceptibility testing and outline the progress in developing better treatment and preventive therapies.
Drug-resistant tuberculosis (TB) is estimated to cause 13% of all antimicrobial resistance-attributable deaths worldwide and is driven by both ongoing resistance acquisition and person-to-person transmission. Poor outcomes are exacerbated by late diagnosis and inadequate access to effective treatment. Advances in rapid molecular testing have recently improved the diagnosis of TB and drug resistance. Next-generation sequencing of Mycobacterium tuberculosis has increased our understanding of genetic resistance mechanisms and can now detect mutations associated with resistance phenotypes. All-oral, shorter drug regimens that can achieve high cure rates of drug-resistant TB within 6–9 months are now available and recommended but have yet to be scaled to global clinical use. Promising regimens for the prevention of drug-resistant TB among high-risk contacts are supported by early clinical trial data but final results are pending. A person-centred approach is crucial in managing drug-resistant TB to reduce the risk of poor treatment outcomes, side effects, stigma and mental health burden associated with the diagnosis. In this Review, we describe current surveillance of drug-resistant TB and the causes, risk factors and determinants of drug resistance as well as the stigma and mental health considerations associated with it. We discuss recent advances in diagnostics and drug-susceptibility testing and outline the progress in developing better treatment and preventive therapies. In this Review, Pai and colleagues examine the global landscape of drug-resistant tuberculosis, exploring its epidemiology, causes, risk factors, stigma and associated mental health burden as well as discussing the most recent developments in diagnostics, treatment and preventive regimens.
Author Rodrigues, Camilla
Vambe, Debrah
Pai, Madhukar
Abd El Aziz, Mirna S.
Enkh-Amgalan, Handaa
Furin, Jennifer
Farhat, Maha
Denkinger, Claudia M.
Ghanem, Marwan
Cox, Helen
Ugarte-Gil, Cesar
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  organization: Institute of Infectious Disease and Molecular Medicine, Wellcome Centre for Infectious Disease Research and Division of Medical Microbiology, University of Cape Town
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  organization: Department of Biomedical Informatics, Harvard Medical School
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  surname: Denkinger
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  fullname: Vambe, Debrah
  organization: National TB Control Programme
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  surname: Ugarte-Gil
  fullname: Ugarte-Gil, Cesar
  organization: School of Public and Population Health, University of Texas Medical Branch
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  givenname: Jennifer
  surname: Furin
  fullname: Furin, Jennifer
  organization: Department of Global Health and Social Medicine, Harvard Medical School
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  orcidid: 0000-0003-3667-4536
  surname: Pai
  fullname: Pai, Madhukar
  email: madhukar.pai@mcgill.ca
  organization: McGill International TB Centre, McGill University
BackLink https://www.ncbi.nlm.nih.gov/pubmed/38519618$$D View this record in MEDLINE/PubMed
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Snippet Drug-resistant tuberculosis (TB) is estimated to cause 13% of all antimicrobial resistance-attributable deaths worldwide and is driven by both ongoing...
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SubjectTerms 631/326/107
631/326/22/1434
631/326/41/1470
631/326/41/2529
631/326/421
Antimicrobial resistance
Antitubercular Agents - pharmacology
Antitubercular Agents - therapeutic use
Biomedical and Life Sciences
Diagnosis
Disease transmission
Drug resistance
Epidemiology
Gene sequencing
Global Health
Humans
Infectious Diseases
Life Sciences
Medical Microbiology
Mental health
Microbiology
Mycobacterium tuberculosis - drug effects
Mycobacterium tuberculosis - genetics
Next-generation sequencing
Parasitology
Phenotypes
Public health
Resistance factors
Review Article
Risk factors
Risk reduction
Side effects
Stigma
Tuberculosis
Tuberculosis, Multidrug-Resistant - diagnosis
Tuberculosis, Multidrug-Resistant - drug therapy
Tuberculosis, Multidrug-Resistant - epidemiology
Virology
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Title Drug-resistant tuberculosis: a persistent global health concern
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