Impact of the COVID-19 Pandemic on Drug-Resistant Tuberculosis in Europe: A Meta-Analysis of Epidemiological Trends

Background/Objectives: The COVID-19 pandemic has significantly intensified global concerns surrounding antimicrobial resistance (AMR), particularly in relation to tuberculosis (TB). In the European Union (EU), the reallocation of healthcare resources towards managing COVID-19 led to a de-prioritization of TB surveillance and control. This shift contributed to delays in TB diagnosis and treatment, creating conditions favorable for the emergence and spread of drug-resistant TB strains. This meta-analysis aims to assess epidemiological trends of drug-resistant TB across EU countries before, during, and after the pandemic and quantify the impact of COVID-19 on Mycobacterium tuberculosis resistance patterns. Methods: Data were obtained from the European Centre for Disease Prevention and Control (ECDC) covering 2015 to 2022. Following the TB incidence, the multidrug-resistant TB (MDR-TB) and rifampicin-resistant/MDR-TB (RR/MDR-TB) cases, as well as treatment success rates over 12- and 24-month periods, were analyzed. The analysis included 31 EU countries across three-time frames: pre-pandemic (2015-2019), pandemic onset (2020), and post-pandemic transition (2020-2022). Results: The pandemic was associated with a decrease in reported TB cases but a simultaneous increase in the proportion of MDR and RR/MDR cases. Treatment success rates showed a modest rise for 24-month regimens, while outcomes declined for 12-month therapies. Conclusions: These findings underscore the pandemic's disruptive impact on TB control and highlight the need for renewed investment in diagnostic capacity, treatment access, and antimicrobial stewardship, in order to reduce antimicrobial resistance occurrence. Continued monitoring beyond 2022 is essential to fully understand long-term effects and inform future public health strategies.