Global trends in the proportion of macrolide-resistant Mycobacterium Species: A systematic review and meta-analysis

Background: Macrolide resistance in Mycobacterium species is an emerging global problem, complicating treating non-tuberculous mycobacteria (NTM) and Mycobacterium tuberculosis. Understanding global resistance patterns is essential to improve treatment strategies and reduce morbidity and mortality. Objective: This study aimed to investigate macrolide resistance prevalence, distribution, and trends among Mycobacterium species in different world regions. Methods: A comprehensive search of Scopus, PubMed, Web of Science, and EMBASE (2015–2023) assessed study quality using JBI guidelines. Resistance proportions were calculated with a random-effects model, and additional meta-regression and subgroup analyses explored variations and trends. Statistical analyses were conducted using R and the metafor package. Results: Out of 5,718 records, 41 studies across 17 countries were included. Azithromycin resistance was reported in 17 reports (3 Studies), with 156 resistant isolates among 715 tested, yielding a pooled rate of 29.0% (95% CI: 19.5–40.7%). Clarithromycin resistance, assessed in 76 reports (40 Studies), included 1,071 resistant isolates among 3,923 tested, with a pooled rate of 30.5% (95% CI: 23.7–38.2%). Erythromycin resistance was reported in 17 reports (3 Studies), with 350 resistant isolates among 752 tested, giving a pooled rate of 50.3% (95% CI: 37.5–62.9%). Meta-regression revealed a significant upward trend in azithromycin resistance over time (r = 0.558, p = 0.005). Conclusion: These findings underscore the need for targeted, region- and species-specific interventions to combat rising macrolide resistance in Mycobacterium species effectively.