AUTHOR=Azimi Taher , Khoshnood Saeed , Asadi Arezoo , Heidary Mohsen , Mahmoudi Hassan , Kaviar Vahab Hassan , Hallajzadeh Masoume , Nasiri Mohammad Javad 

TITLE=Linezolid resistance in multidrug-resistant mycobacterium tuberculosis: A systematic review and meta-analysis

JOURNAL=Frontiers in Pharmacology

VOLUME=13

YEAR=2022

URL=https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2022.955050

DOI=10.3389/fphar.2022.955050

ISSN=1663-9812

ABSTRACT=<p><bold>Introduction:</bold> Linezolid (LNZ) is an effective antibiotic to treat patients with multidrug-resistant tuberculosis (MDR-TB) treatment failure. <italic>M. tuberculosis</italic> strains resistant to isoniazid and rifampin are defined as MDR-TB. In recent years, resistance to LNZ among MDR-TB cases has been reported in several different countries. In this study, we performed a systematic review and meta-analysis to investigate the prevalence of LNZ resistance among MDR-TB isolates.</p><p><bold>Methods:</bold> The databases of Embase, PubMed/Medline, and Web of Science were searched systematically from January 2000 to April 2021. Statistical analyses were performed by using Comprehensive Meta-Analysis software. Heterogeneity was reported by using the t-squared statistic and Q-statistic. Begg’s rank correlation in combination with the funnel plot were used to evaluate any possible publication bias.</p><p><bold>Results:</bold> In total, 25 studies were selected for meta-analysis from 14 different countries; the majority was from China (n = 5) and Turkey (n = 4). Moreover, 7,366 patients were infected with MDR <italic>M. tuberculosis</italic>. Among the study population, 98 patients were co-infected with HIV, and 18 patients with hepatitis C virus (HCV). Furthermore, 28 cases had diabetes, and139 cases were alcohol abuser. Overall, 4,956 MDR <italic>M. tuberculosis</italic> strains were isolated from TB patients. The pooled frequency of LNZ resistance among the clinical isolates of MDR <italic>M. tuberculosis</italic> was 4.2% (95%). Begg’s (<italic>p</italic> = 0.72) test showed no evidence of publication bias.</p><p><bold>Conclusion:</bold> LNZ resistance among MDR M. tuberculosis isolates is increasing. On the other hand, long-term treatment of MDR-TB cases with LNZ alone is associated with several adverse effects. Thus, it is recommended that newer anti-TB drugs, including bedaquiline and delamanid, in combination with linezolid could increase its effectiveness and decrease toxicities. However, more studies should be done in this field.</p>