Antimicrobial susceptibility pattern in non-tuberculous mycobacteria in Iran: a systematic review

Non-tuberculous mycobacteria (NTM) are ubiquitous environmental bacteria that can cause a variety of infections in humans, particularly those with underlying lung diseases. These infections are increasing worldwide and their antimicrobial susceptibility has decreased even more than that of tuberculous mycobacteria. Therefore, determining the local antimicrobial susceptibility of NTM can provide appropriate treatment strategies. This study, conducted based on the PRISMA statement, is a systematic review to assess non-tuberculous mycobacteria (NTM) prevalence and drug susceptibility patterns in Iran between 2012 and 2023. Data was extracted from various databases and screened for eligibility using the Rayyan app. Thirteen studies were included with clinical and environmental samples. Most of the studies were tested for antimicrobial susceptibility based on the CLSI broth dilution method. NTM species varied widely in their susceptibility to common antibiotics. They were generally less susceptible to first-line antituberculosis drugs and meropenem, and predominantly sensitive to amikacin and secondly clarithromycin. Although NTM isolates are widespread in Iran and have increased resistance to common TB drugs, there is no evidence of this in the literature yet. Our systematic review suggests that amikacin is the most effective drug against almost all NTM species common in Iran.