A systematic review and meta-analysis of studies on the diagnostic accuracy and screening of tests to detect antimicrobial resistance in leprosy

Diagn Microbiol Infect Dis. 2021 May;100(1):115325. doi: 10.1016/j.diagmicrobio.2021.115325. Epub 2021 Jan 27.

Abstract

Although multidrug therapy is considered an effective treatment for leprosy, antimicrobial resistance is a serious concern. We performed a systematic review of studies on the diagnostic accuracy and screening of tests for antimicrobial resistance in leprosy. This review was registered in PROSPERO (CRD42020177958). In April 2020, we searched for studies in the PubMed, EMBASE, Web of Science, Scopus, Scielo, and LILACS databases. A random effects regression model was used for the meta-analysis. We included 129 studies. Molecular tests for dapsone resistance had a sensitivity of 78.8% (95% confidence interval [CI] = 65.6-87.9) and a specificity of 97.0% (95% CI = 94.0-98.6). Molecular tests for rifampicin resistance had a sensitivity and specificity of 88.7% (95% CI = 80.0-93.9) and 97.3% (95% CI = 94.3-98.8), respectively. Molecular tests for ofloxacin resistance had a sensitivity and specificity of 80.9% (95% CI = 60.1-92.3) and 96.1% (95% CI = 90.2-98.5), respectively. In recent decades, no increase in the resistance proportion was detected. However, the growing number of resistant cases is still a clinical concern.

Keywords: Bacterial; Diagnosis; Drug resistance; Leprosy; Meta-analysis; Sequence analysis, DNA.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Anti-Bacterial Agents / pharmacology*
  • DNA, Bacterial / genetics
  • Drug Resistance, Bacterial*
  • Humans
  • Leprosy* / diagnosis
  • Leprosy* / microbiology
  • Microbial Sensitivity Tests* / methods
  • Microbial Sensitivity Tests* / standards
  • Mycobacterium leprae / drug effects*
  • Sensitivity and Specificity
  • Sequence Analysis, DNA

Substances

  • Anti-Bacterial Agents
  • DNA, Bacterial