Improving treatment outcomes of tuberculosis: towards an antimicrobial stewardship program

Objectives: Since the risk of multidrug-resistant tuberculosis (MDR-TB) may depend on the setting, we aimed to determine the associations of risk factors of MDR-TB across different regions. Methods:A systematic review and meta-analysis was performed with Pubmed and Embase databases.Information was retrieved on 37 pre-defined risk factors of MDR-TB.We estimated overall Mantel-Haenszel odds ratio as a measure of the association. Results: Factors of previous TB disease and treatment are the most important risk factors associated with MDR-TB.There was also a trend towards increased risk of MDR-TB for patients 40 years and older, unemployed, lacking health insurance, smear positive, with non-completion and failure of TB treatment, showing adverse drug reaction, non-adherent, HIV positive, with COPD and with M. Tuberculosis Beijing infection.Effect modification by geographical area was identified for several risk factors such as male gender, married patients, urban domicile, homelessness and history of imprisonment.Conclusions: Assessment of risk factors of MDR-TB should be conducted regionally to develop the most effective strategy for MDR-TB control.Across all regions, factors associated with previous TB disease and treatment are essential risk factors, indicating the appropriateness of diagnosis, treatment and monitoring are an important requirements.