Bedaquiline susceptibility testing of Mycobacterium abscessus complex and Mycobacterium avium complex: a meta-analysis study

Objective This study aims to estimate the overall in vitro activity of bedaquiline (BDQ) against clinical isolates of Mycobacterium abscessus complex (MABS) and Mycobacterium avium complex (MAC), considering BDQ as a repurposed drug for non-tuberculous mycobacteria (NTM) infections. Methods We conducted a systematic review of publications in PubMed/ MEDLINE, Web of Science, and Embase up to April 15, 2023. Studies were included if they followed the Clinical and Laboratory Standards Institute (CLSI) criteria for drug susceptibility testing (DST). Using a random effects model, we assessed the overall in vitro BDQ resistance rate in clinical isolates of MABS and MAC. Sources of heterogeneity were analyzed using Cochran's Q and the I2 statistic. All analyses were performed using CMA V3.0. Results A total of 24 publications (19 reports for MABS and 11 for MAC) were included. Using 1 μg/mL and 2 μg/mL as the breakpoint for BDQ resistance, the pooled rates of in vitro BDQ resistance in clinical isolates of MABS were found to be 1.8% (95% confidence interval [CI], 0.7–4.6%) and 1.7% (95% CI, 0.6–4.4%), respectively. In the case of MAC, the pooled rates were 1.7% (95% CI, 0.4–6.9%) and 1.6% (95% CI, 0.4–6.8%) for 1 μg/mL and 2 μg/mL, respectively. Conclusion This study reports the prevalence of BDQ resistance in clinical isolates of MABS and MAC. The findings suggest that BDQ holds potential as a repurposed drug for treating MABS and MAC infections.