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Vijay S, Bao NLH, Vinh DN, Nhat LTH, Thu DDA, Quang NL, Trieu LPT, Nhung HN, Ha VTN, Thai PVK, Ha DTM, Lan NH, Caws M, Thwaites GE, Javid B, Thuong NTT. Rifampicin tolerance and growth fitness among isoniazid-resistant clinical Mycobacterium tuberculosis isolates: an in-vitro longitudinal study. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2023.11.22.568240. [PMID: 38045287 PMCID: PMC10690245 DOI: 10.1101/2023.11.22.568240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Antibiotic tolerance in Mycobacterium tuberculosis leads to less effective bacterial killing, poor treatment responses and resistant emergence. Therefore, we investigated the rifampicin tolerance of M. tuberculosis isolates, with or without pre-existing isoniazid-resistance. We determined the in-vitro rifampicin survival fraction by minimum duration of killing assay in isoniazid susceptible (IS, n=119) and resistant (IR, n=84) M. tuberculosis isolates. Then we correlated the rifampicin tolerance with bacterial growth, rifampicin minimum inhibitory concentrations (MICs) and isoniazid-resistant mutations. The longitudinal IR isolates collected from patients were analyzed for changes in rifampicin tolerance and associated emergence of genetic variants. The median duration of rifampicin exposure reducing the M. tuberculosis surviving fraction by 90% (minimum duration of killing-MDK90) increased from 1.23 (95%CI 1.11; 1.37) and 1.31 (95%CI 1.14; 1.48) to 2.55 (95%CI 2.04; 2.97) and 1.98 (95%CI 1.69; 2.56) days, for IS and IR respectively, during 15 to 60 days of incubation. This indicated the presence of fast and slow growing tolerant sub-populations. A range of 6 log 10 -fold survival fraction enabled classification of tolerance as low, medium or high and revealed IR association with increased tolerance with faster growth (OR=2.68 for low vs. medium, OR=4.42 for low vs. high, P -trend=0.0003). The high tolerance in IR isolates was specific to those collected during rifampicin treatment in patients and associated with bacterial genetic microvariants. Furthermore, the high rifampicin tolerant IR isolates have survival potential similar to multi-drug resistant isolates. These findings suggest that IR tuberculosis needs to be evaluated for high rifampicin tolerance to improve treatment regimen and prevent the risk of MDR-TB emergence.
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Spies R, Hong HN, Trieu PP, Lan LK, Lan K, Hue NN, Huong NTL, Thao TTLN, Quang NL, Anh TDD, Vinh TV, Ha DTM, Dat PT, Hai NP, Van LH, Thwaites GE, Thuong NTT, Watson JA, Walker TM. Spatial Analysis of Drug-Susceptible and Multidrug-Resistant Cases of Tuberculosis, Ho Chi Minh City, Vietnam, 2020-2023. Emerg Infect Dis 2024; 30:499-509. [PMID: 38407176 PMCID: PMC10902525 DOI: 10.3201/eid3003.231309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024] Open
Abstract
We characterized the spatial distribution of drug-susceptible (DS) and multidrug-resistant (MDR) tuberculosis (TB) cases in Ho Chi Minh City, Vietnam, a major metropolis in southeastern Asia, and explored demographic and socioeconomic factors associated with local TB burden. Hot spots of DS and MDR TB incidence were observed in the central parts of Ho Chi Minh City, and substantial heterogeneity was observed across wards. Positive spatial autocorrelation was observed for both DS TB and MDR TB. Ward-level TB incidence was associated with HIV prevalence and the male proportion of the population. No ward-level demographic and socioeconomic indicators were associated with MDR TB case count relative to total TB case count. Our findings might inform spatially targeted TB control strategies and provide insights for generating hypotheses about the nature of the relationship between DS and MDR TB in Ho Chi Minh City and the wider southeastern region of Asia.
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Malhotra A, Thompson R, De Vos M, David A, Schumacher S, Sohn H. Determining cost and placement decisions for moderate complexity NAATs for tuberculosis drug susceptibility testing. PLoS One 2023; 18:e0290496. [PMID: 37616318 PMCID: PMC10449112 DOI: 10.1371/journal.pone.0290496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 08/10/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Access to drug resistant testing for tuberculosis (TB) remains a challenge in high burden countries. Recently, the World Health Organization approved the use of several moderate complexity automated nucleic acid amplification tests (MC-NAAT) that have performance profiles suitable for placement in a range of TB laboratory tiers to improve drug susceptibility tests (DST) coverage. METHODS We conducted cost analysis of two MC-NAATs with different testing throughput: Lower Throughput (LT, < 24 tests per run) and Higher Throughput (HT, upto 90+ tests per run) for placement in a hypothetical laboratory in a resource limited setting. We used per-test cost as the main indicator to assess 1) drivers of cost by resource types and 2) optimized levels of annual testing volumes for the respective MC-NAATs. RESULTS The base-case per test cost of $18.52 (range: $13.79 - $40.70) for LT test and $15.37 (range: $9.61 - $37.40) for HT test. Per test cost estimates were most sensitive to the number of testing days per week, followed by equipment costs and TB-specific workloads. In general, HT NAATs were cheaper at all testing volume levels, but at lower testing volumes (less than 2,000 per year) LT tests can be cheaper if the durability of the testing system is markedly better and/or procured equipment costs are lower than that of HT NAAT. CONCLUSION Assuming equivalent performance and infrastructural needs, placement strategies for MC-NAATs need to be prioritized by laboratory system's operational factors, testing demands, and costs.
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Affiliation(s)
- Akash Malhotra
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Ryan Thompson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Margaretha De Vos
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Anura David
- University of the Witwatersrand, Johannesburg, South Africa
| | | | - Hojoon Sohn
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, South Korea
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Zhang M, Lu Y, Zhu Y, Wu K, Chen S, Zhou L, Wang F, Peng Y, Li X, Pan J, Chen B, Liu Z, Wang X. Whole-Genome Sequencing to Predict Mycobacterium tuberculosis Drug Resistance: A Retrospective Observational Study in Eastern China. Antibiotics (Basel) 2023; 12:1257. [PMID: 37627677 PMCID: PMC10451829 DOI: 10.3390/antibiotics12081257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/27/2023] [Accepted: 07/27/2023] [Indexed: 08/27/2023] Open
Abstract
Pulmonary tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis (MTB). Whole-genome sequencing (WGS) holds great promise as an advanced technology for accurately predicting anti-TB drug resistance. The development of a reliable method for detecting drug resistance is crucial in order to standardize anti-TB treatments, enhance patient prognosis, and effectively reduce the risk of transmission. In this study, our primary objective was to explore and determine the potential of WGS for assessing drug resistance based on genetic variants recommended by the World Health Organization (WHO). A total of 1105 MTB strains were selected from samples collected from 2014-2018 in Zhejiang Province, China. Phenotypic drug sensitivity tests (DST) of the anti-TB drugs were conducted for isoniazid (INH), rifampicin (RFP), streptomycin, ethambutol, fluoroquinolones (levofloxacin and moxifloxacin), amikacin, kanamycin, and capreomycin, and the drug-resistance rates were calculated. The clean WGS data of the 1105 strains were acquired and analyzed. The predictive performance of WGS was evaluated by the comparison between genotypic and phenotypic DST results. For all anti-TB drugs, WGS achieved good specificity values (>90%). The sensitivity values for INH and RFP were 91.78% and 82.26%, respectively; however, they were ≤60% for other drugs. The positive predictive values for anti-TB drugs were >80%, except for ethambutol and moxifloxacin, and the negative predictive values were >90% for all drugs. In light of the findings from our study, we draw the conclusion that WGS is a valuable tool for identifying genome-wide variants. Leveraging the genetic variants recommended by the WHO, WGS proves to be effective in detecting resistance to RFP and INH, enabling the identification of multi-drug resistant TB patients. However, it is evident that the genetic variants recommended for predicting resistance to other anti-TB drugs require further optimization and improvement.
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Affiliation(s)
- Mingwu Zhang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China; (M.Z.); (Y.Z.); (K.W.); (S.C.); (L.Z.); (F.W.); (Y.P.); (J.P.); (B.C.)
| | - Yewei Lu
- Key Laboratory of Precision Medicine in Diagnosis and Monitoring Research of Zhejiang Province, Hangzhou 310020, China; (Y.L.); (X.L.)
| | - Yelei Zhu
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China; (M.Z.); (Y.Z.); (K.W.); (S.C.); (L.Z.); (F.W.); (Y.P.); (J.P.); (B.C.)
| | - Kunyang Wu
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China; (M.Z.); (Y.Z.); (K.W.); (S.C.); (L.Z.); (F.W.); (Y.P.); (J.P.); (B.C.)
| | - Songhua Chen
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China; (M.Z.); (Y.Z.); (K.W.); (S.C.); (L.Z.); (F.W.); (Y.P.); (J.P.); (B.C.)
| | - Lin Zhou
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China; (M.Z.); (Y.Z.); (K.W.); (S.C.); (L.Z.); (F.W.); (Y.P.); (J.P.); (B.C.)
| | - Fei Wang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China; (M.Z.); (Y.Z.); (K.W.); (S.C.); (L.Z.); (F.W.); (Y.P.); (J.P.); (B.C.)
| | - Ying Peng
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China; (M.Z.); (Y.Z.); (K.W.); (S.C.); (L.Z.); (F.W.); (Y.P.); (J.P.); (B.C.)
| | - Xiangchen Li
- Key Laboratory of Precision Medicine in Diagnosis and Monitoring Research of Zhejiang Province, Hangzhou 310020, China; (Y.L.); (X.L.)
| | - Junhang Pan
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China; (M.Z.); (Y.Z.); (K.W.); (S.C.); (L.Z.); (F.W.); (Y.P.); (J.P.); (B.C.)
| | - Bin Chen
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China; (M.Z.); (Y.Z.); (K.W.); (S.C.); (L.Z.); (F.W.); (Y.P.); (J.P.); (B.C.)
| | - Zhengwei Liu
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China; (M.Z.); (Y.Z.); (K.W.); (S.C.); (L.Z.); (F.W.); (Y.P.); (J.P.); (B.C.)
| | - Xiaomeng Wang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China; (M.Z.); (Y.Z.); (K.W.); (S.C.); (L.Z.); (F.W.); (Y.P.); (J.P.); (B.C.)
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Otchere ID, Morgan PA, Asare P, Osei-Wusu S, Aboagye SY, Yirenkyi SO, Musah AB, Danso EK, Tetteh-Ocloo G, Afum T, Asante-Poku A, Laryea C, Poku YA, Bonsu F, Gagneux S, Yeboah-Manu D. Analysis of drug resistance among difficult-to-treat tuberculosis patients in Ghana identifies several pre-XDR TB cases. Front Microbiol 2023; 13:1069292. [PMID: 36713197 PMCID: PMC9878308 DOI: 10.3389/fmicb.2022.1069292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 12/28/2022] [Indexed: 01/14/2023] Open
Abstract
Background Resistance to tuberculosis (TB) drugs has become a major threat to global control efforts. Early case detection and drug susceptibility profiling of the infecting bacteria are essential for appropriate case management. The objective of this study was to determine the drug susceptibility profiles of difficult-to-treat (DTT) TB patients in Ghana. Methods Sputum samples obtained from DTT-TB cases from health facilities across Ghana were processed for rapid diagnosis and detection of drug resistance using the Genotype MTBDRplus and Genotype MTBDRsl.v2 from Hain Life science. Results A total of 298 (90%) out of 331 sputum samples processed gave interpretable bands out of which 175 (58.7%) were resistant to at least one drug (ANYr); 16.8% (50/298) were isoniazid-mono-resistant (INHr), 16.8% (50/298) were rifampicin-mono-resistant (RIFr), and 25.2% (75/298) were MDR. 24 (13.7%) of the ANYr were additionally resistant to at least one second line drug: 7.4% (2 RIFr, 1 INHr, and 10 MDR samples) resistant to only FQs and 2.3% (2 RIFr, 1 INHr, and 1 MDR samples) resistant to AMG drugs kanamycin (KAN), amikacin (AMK), capreomycin (CAP), and viomycin (VIO). Additionally, there were 4.0% (5 RIFr and 2 MDR samples) resistant to both FQs and AMGs. 81 (65.6%) out of 125 INH-resistant samples including INHr and MDR had katG-mutations (MT) whereas 15 (12%) had inhApro-MT. The remaining 28 (22.4%) had both katG and inhA MT. All the 19 FQ-resistant samples were gyrA mutants whereas the 10 AMGs were rrs (3), eis (3) as well as rrs, and eis co-mutants (4). Except for the seven pre-XDR samples, no sample had eis MT. Conclusion The detection of several pre-XDR TB cases in Ghana calls for intensified drug resistance surveillance and monitoring of TB patients to, respectively, ensure early diagnosis and treatment compliance.
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Affiliation(s)
- Isaac Darko Otchere
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Portia Abena Morgan
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Prince Asare
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Stephen Osei-Wusu
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Samuel Yaw Aboagye
- Institute for Environment and Sanitation Studies, College of Basic and Applied Sciences, University of Ghana, Accra, Ghana
| | | | - Abdul Basit Musah
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Emelia Konadu Danso
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | | | - Theophilus Afum
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Adwoa Asante-Poku
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | | | - Yaw Adusi Poku
- National Tuberculosis Control Program, Ghana Health Service, Accra, Ghana
| | - Frank Bonsu
- National Tuberculosis Control Program, Ghana Health Service, Accra, Ghana
| | - Sebastien Gagneux
- Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | - Dorothy Yeboah-Manu
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
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Li Y, Shi J, Song W, Shao Y, Zhu L, Chen C. A retrospective Cohort Study on the Treatment Outcomes and Genotyping of Isoniazid-Resistant Tuberculosis Patients in Eastern China. J Glob Antimicrob Resist 2022; 30:335-339. [PMID: 35817264 DOI: 10.1016/j.jgar.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/31/2022] [Accepted: 07/01/2022] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVES Isoniazid resistance might be overlooked due to the priority of detection of rifampicin-resistant tuberculosis. It was urgent to reveal the current situation of isoniazid-resistant tuberculosis (HR-TB), including unfavorable outcomes and bacterial factors. METHODS A retrospective cohort study was undertaken by enrolling 120 HR-TB and 193 drug-sensitive tuberculosis (DS-TB). 24 loci MIRU-VNTR and Spoligotyping were adopted for genotyping. RESULTS We found 106 (88.3%) HR-TB and 165(85.5%) DS-TB were treated with the first-line drugs. Meanwhile, 12 (10.0%) patients of the HR-TB and 7 (3.63%) patients of the DS-TB involved adverse treatment outcomes, respectively. (χ2 =5.271, P=0.028). A total of 78 DNAs from HR Mycobacterium tuberculosis and 114 DNAs from DS Mycobacterium tuberculosis were available for MIRU-VNTR and Spoligotyping. The clustering rate was 17.9% (14/78) for HR-TB and 16.7% (19/114) for DS-TB, and reached no significant difference (χ2 =0.05, P=0.8171). The Beijing family strains accounted for 83.7% (65/78) among HR-TB, 80.0% (91/114) among DS-TB (χ2=0.37, P=0.5407). The adverse treatment outcomes for HR-TB all occurred in patients infected with Beijing family strains (13.8%), but no difference was found between Beijing and non-Beijing genotypes (P=0.342). CONCLUSION the adverse outcome of HR-TB was significantly higher than that of DS-TB, and most of the HR-TB patients were receiving a standard first-line regimen. Although the clustering rate and Beijing genotype distribution among HR-TB and DS-TB showed no significant difference, Beijing genotype was the dominant genotype and the proportion of Beijing genotype was only slightly high among HR-TB than DS-TB.
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Affiliation(s)
- Yishu Li
- Center for Disease Control and Prevention of Wuzhong District, Suzhou, Jiangsu Province, PR China; Department of Epidemiology and Statistics, School of Public Health, Southeast University, Nanjing, Jiangsu Province, PR China
| | - Jinyan Shi
- The Fourth Hospital of Lianyungang City, Lianyungang, Jiangsu Province, PR China
| | - Wenlei Song
- Center for Disease Control and Prevention of Kunshan, Suzhou, Jiangsu Province, PR China
| | - Yan Shao
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu Province, PR China
| | - Limei Zhu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu Province, PR China
| | - Cheng Chen
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu Province, PR China.
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Shu Q, Rajagopal M, Fan J, Zhan L, Kong X, He Y, Rotcheewaphan S, Lyon CJ, Sha W, Zelazny AM, Hu T. Peptidomic analysis of mycobacterial secreted proteins enables species identification. VIEW 2022. [DOI: 10.1002/viw.20210019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Qingbo Shu
- Center for Cellular and Molecular Diagnostics Department of Biochemistry and Molecular Biology School of Medicine Tulane University New Orleans Louisiana USA
| | - Meena Rajagopal
- Department of Laboratory Medicine, Clinical Center National Institutes of Health Bethesda Maryland USA
| | - Jia Fan
- Center for Cellular and Molecular Diagnostics Department of Biochemistry and Molecular Biology School of Medicine Tulane University New Orleans Louisiana USA
| | - Lingpeng Zhan
- Center for Cellular and Molecular Diagnostics Department of Biochemistry and Molecular Biology School of Medicine Tulane University New Orleans Louisiana USA
| | - Xiangxing Kong
- Center for Cellular and Molecular Diagnostics Department of Biochemistry and Molecular Biology School of Medicine Tulane University New Orleans Louisiana USA
| | - Yifan He
- Clinic and Research Center of Tuberculosis, Shanghai Pulmonary Hospital Tongji University School of Medicine Shanghai People's Republic of China
| | - Suwatchareeporn Rotcheewaphan
- Department of Laboratory Medicine, Clinical Center National Institutes of Health Bethesda Maryland USA
- Department of Microbiology, Faculty of Medicine Chulalongkorn University Bangkok Thailand
| | - Christopher J. Lyon
- Center for Cellular and Molecular Diagnostics Department of Biochemistry and Molecular Biology School of Medicine Tulane University New Orleans Louisiana USA
| | - Wei Sha
- Clinic and Research Center of Tuberculosis, Shanghai Pulmonary Hospital Tongji University School of Medicine Shanghai People's Republic of China
| | - Adrian M. Zelazny
- Department of Laboratory Medicine, Clinical Center National Institutes of Health Bethesda Maryland USA
| | - Tony Hu
- Center for Cellular and Molecular Diagnostics Department of Biochemistry and Molecular Biology School of Medicine Tulane University New Orleans Louisiana USA
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Zhu J, Bao Z, Xie Y, Werngren J, Hu Y, Davies Forsman L, Bruchfeld J, Hoffner S. Additional drug resistance for Mycobacterium tuberculosis during turnaround time for drug-susceptibility testing in China: A multicenter observational cohort study. Int J Infect Dis 2021; 108:81-88. [PMID: 33862209 DOI: 10.1016/j.ijid.2021.04.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Although phenotypic drug susceptibility testing (DST) of Mycobacterium tuberculosis (Mtb) takes up to 6-8 weeks, little is known about how drug susceptibility is affected during this period. METHODS We performed a prospective cohort study to investigate the development of drug resistance (DR) during turnaround time (TAT), including 359 pulmonary tuberculosis (PTB) patients with a baseline DST result of an Mtb isolate collected at TB diagnosis and a follow-up DST result of an Mtb isolate collected when baseline DST result was available between 2013 and 2018. Whole-genome sequencing (WGS) was used to differentiate between acquired drug resistance, exogenous reinfection, and mixed infection. RESULTS Among the studied patients, during TAT for DST, 116 (32.3%) developed DR to four first-line drugs (rifampicin, isoniazid, pyrazinamide, ethambutol). Among 116 pairs of isolates included for WGS, 21 pairs were classified as acquired drug resistance with single nucleotide polymorphisms (SNPs) differences less than 12. Four pairs with an intermediate SNPs differences displayed minor differences in related genotypes and were assessed as mixed infection. The remaining 91 pairs had high SNPs differences consistent with exogenous reinfection. CONCLUSIONS The exogenous reinfection of drug-resistant strains played a vital role in the development of DR of Mtb isolates during TAT for DST, highlighting the need for both rapid DST methods and improved infection control.
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Affiliation(s)
- Jiahui Zhu
- School of Public Health and Key Laboratory of Public Health Safety, Fudan University, Shanghai, China
| | - Ziwei Bao
- The Fifth People's Hospital of Suzhou, Infectious Disease Hospital Affiliated to Soochow University, Suzhou, China
| | - Yan Xie
- Department Tuberculosis Control, Zigong Center for Disease Control and Prevention, Zigong, China
| | - Jim Werngren
- Department of Microbiology, The Public Health Agency of Sweden, Stockholm, Sweden
| | - Yi Hu
- School of Public Health and Key Laboratory of Public Health Safety, Fudan University, Shanghai, China.
| | - Lina Davies Forsman
- Department of Infectious Disease, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Division of Infectious Diseases, Karolinska Institutet Solna, Sweden
| | - Judith Bruchfeld
- Department of Infectious Disease, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Division of Infectious Diseases, Karolinska Institutet Solna, Sweden
| | - Sven Hoffner
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
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Most-Probable-Number-Based Minimum Duration of Killing Assay for Determining the Spectrum of Rifampicin Susceptibility in Clinical Mycobacterium tuberculosis Isolates. Antimicrob Agents Chemother 2021; 65:AAC.01439-20. [PMID: 33257450 PMCID: PMC8092508 DOI: 10.1128/aac.01439-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 11/24/2020] [Indexed: 12/17/2022] Open
Abstract
Accurate antibiotic susceptibility testing is essential for successful tuberculosis treatment. Recent studies have highlighted the limitations of MIC-based phenotypic susceptibility methods in detecting other aspects of antibiotic susceptibilities in bacteria. Duration and peak of antibiotic exposure, at or above the MIC required for killing the bacterial population, has emerged as another important factor for determining antibiotic susceptibility. This is broadly defined as antibiotic tolerance. Accurate antibiotic susceptibility testing is essential for successful tuberculosis treatment. Recent studies have highlighted the limitations of MIC-based phenotypic susceptibility methods in detecting other aspects of antibiotic susceptibilities in bacteria. Duration and peak of antibiotic exposure, at or above the MIC required for killing the bacterial population, has emerged as another important factor for determining antibiotic susceptibility. This is broadly defined as antibiotic tolerance. Antibiotic tolerance can further facilitate the emergence of antibiotic resistance. Currently, there are limited methods to quantify antibiotic tolerance among clinical M. tuberculosis isolates. In this study, we develop a most-probable-number (MPN)-based minimum duration of killing (MDK) assay to quantify the spectrum of M. tuberculosis rifampicin susceptibility within subpopulations based on the duration of rifampicin exposure required for killing the bacterial population. MDK90–99 and MDK99.99 were defined as the minimum duration of antibiotic exposure at or above the MIC required for killing 90 to 99% and 99.99% of the initial (pretreatment) bacterial population, respectively. Results from the rifampicin MDK assay applied to 28 laboratory and clinical M. tuberculosis isolates showed that there is variation in rifampicin susceptibility among isolates. The rifampicin MDK99/99.99 time for isolates varied from less than 2 to 10 days. MDK was correlated with larger subpopulations of M. tuberculosis from clinical isolates that were rifampicin tolerant. Our study demonstrates the utility of MDK assays to measure the variation in antibiotic tolerance among clinical M. tuberculosis isolates and further expands clinically important aspects of antibiotic susceptibility testing.
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