# Genotypic diversity of multi- and extensively drug-resistant Mycobacterium tuberculosis in Iran: a systematic review and meta-analysis

## TL;DR

This study identifies the most common drug-resistant tuberculosis bacteria types in Iran, which can help improve treatment strategies.

## Contribution

The study provides a comprehensive meta-analysis of Mtb genotypes in Iran, highlighting dominant drug-resistant strains.

## Key findings

- Haarlem and Beijing genotypes are the most prevalent among MDR/XDR-TB cases in Iran.
- Beijing genotype dominates pre-/XDR-TB cases in Iran.
- Local tracking of drug-resistant Mtb is critical for managing TB treatment failure.

## Abstract

Monitoring the genetic diversity of the drug-resistant Mycobacterium tuberculosis (Mtb) population contributes to gaining better insight into the bacterial dynamics and informing effective strategies to tackle the challenge of drug resistance. This meta-analysis study investigates the pooled prevalence of Mtb genotypes among Iranian multidrug-resistant (MDR)/extensively drug-resistant (XDR)-TB patients.

We performed a systematic search across repositories, including PubMed, Scopus, Web of Science, and Iranian databases, to find studies reporting Mtb genotype prevalence among Iranian MDR/XDR-TB patients through 31 August 2024. Random-effects or fixed-effect models were used to evaluate the pooled proportion. Statistical analysis was conducted using a meta package in R software.

In this meta-analysis, 26 out of 34 included studies focused on MDR genotypes, while the remaining studies addressed the prevalence of pre-/XDR genotypes. The prevalence results for MDR genotypes showed that Haarlem (28.5%, 95% CI: 24.6–32.8), Beijing (25.6%, 95% CI: 22.5–28.9), and URAL (23.8%, 95% CI: 13.3–38.9) were the most predominant genotypes. Genotypes with the lowest proportion included MANU, T, and Uganda ( < 8%). The highest prevalence of pre-/XDR genotypes was identified for Beijing (57.6%, 95% CI: 35.8–76.8) and Haarlem (30.2%, 95% CI: 9.8–63.3), respectively.

Based on our findings, Haarlem and Beijing were highlighted as the dominant circulating genotypes among Iranian MDR- and pre-/XDR-TB cases, respectively. As the relationship between these genotypes and high levels of treatment failure has been documented, local tracking dynamics of drug-resistant Mtb population structure are critical to improving our ability to manage local MDR/XDR-TB.

The online version contains supplementary material available at 10.1186/s12879-025-12299-y.