Global research trends in tuberculosis drug-resistance mechanisms: a bibliometric and cross-database analysis

Drug-resistant tuberculosis (DR-TB) remains a major challenge to global tuberculosis control. In 2024, approximately 390,000 individuals developed multidrug- or rifampicin-resistant tuberculosis (MDR/RR-TB) worldwide, while treatment coverage remained limited to 42%, highlighting persistent gaps in DR-TB management. The mechanisms underlying DR-TB involve resistance-associated mutations, bacterial adaptation, host-pathogen interactions, and drug-target-related processes. A comprehensive evaluation of research trends is needed to clarify the evolution and future directions of this field.

This bibliometric review was conducted with reference to the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) 2020 statement. Publications related to DR-TB mechanisms from January 1, 2006, to May 10, 2026, were retrieved from the Web of Science Core Collection (WoSCC), yielding 1,043 eligible records. VOSviewer, CiteSpace, and bibliometric methods were applied to analyze countries/regions, institutions, authors, journals, keywords, and co-citation networks. An independent PubMed dataset (n = 787) was used for cross-database validation to assess the consistency and robustness of major findings.

Annual publications increased markedly after 2015. The dataset included 6,129 authors from 1,581 institutions across 60 countries/regions. The United States was the leading contributor, with the highest number of publications (248) and citations (2,460). Keyword and thematic analyzes revealed that major research areas included drug resistance mechanisms, combination therapy, microbiological analysis, antitubercular agents, and Mycobacterium tuberculosis. Research evolution demonstrated a transition from traditional studies of bacterial pathology and biosynthesis toward computer-aided target discovery, molecular docking, and host-directed therapies involving programmed cell death pathways such as autophagy. Descriptive country-institution-keyword mapping showed regionally patterned thematic associations, with natural products, nanomaterials, and quorum-sensing inhibition represented among associations involving institutions from Asia and Latin America, and clinical microbiology, genomics, and pathway regulation represented among those involving institutions from North America and Europe. PubMed validation demonstrated comparable publication trends, geographic distributions, and thematic patterns.

The bibliometric landscape of DR-TB mechanism research has broadened from individual molecular targets to bacterial, host-related, and computational themes. Recent studies show increasing attention to host-directed approaches, molecular modeling, and multidimensional analyzes. These trends may inform future mechanistic and translational research, although their biological and clinical relevance requires independent validation.