A study on pattern of resistance to second line anti tubercular drugs among multi drug resistant tuberculosis patients

Sharma, Amit; Gupta, Neeraj; Kala, Dilip Kumar; Patni, Tarun; Dixit, Ramakant; Verma, Satyadeep; Chandran, Arjun

doi:10.1016/j.ijtb.2018.02.005

Cited by 9 publications

(9 citation statements)

References 11 publications

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“…The most common mutation detected by Genotype MTBDRsl in FQ-resistant isolates was a change at codon 94. Among codon 94 mutations, the most prominent mutation was gyrA MUT3C in 139 cases, which was comparable to the studies from South Africa, China, and India [6,7,18]. We found the rare gyrA MUT3D mutation in three cases that is absent in most of the studies, including the recent study from China [13].…”

Section: Discussionsupporting

confidence: 85%

Second-line Drug Resistance Characterization in Mycobacterium tuberculosis by Genotype MTBDRsl Assay

Sethi¹,

Agarwal²,

Khaneja³

et al. 2020

JEGH

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Tuberculosis (TB) remains a main hurdle for national programs due to increase in drug resistance to antitubercular drugs. World Health Organization (WHO)-endorsed Line Probe Assay, Genotype MTBDRsl Ver 2.0, gives opportunity for rapid diagnosis and molecular characterization of different mutations in drug targets of fluoroquinolone (FQ) and second-line injectable drugs (SLID). We, retrospectively, analyzed the data of Genotype MTBDRsl Ver 2.0 from January 2018 to June 2018. A total of 863 isolates of Mycobacterium tuberculosis, 687 rifampicin resistant and 176 isoniazid resistant only, were screened for drug resistance in FQ and SLID. All the isolates were tested for Genotype MTBDRsl Ver 2.0 according to the manufacturer's instructions. The FQ and SLID resistance were detected in 295 (34.2%) and 70 (8.1%) isolates, respectively. Among newly diagnosed and followup rifampicin-resistant TB (RR TB) patients, the FQ resistance was 25.8% and 44.5%, respectively. The most common mutation (42.7%) in FQ-resistant isolates was MUT3C in gyrA gene. Both SLID and FQ resistance were detected in 59 (6.8%) RR TB isolates. The mono SLID resistance was detected in 12 (1.7%) isolates of RR TB. Genotype MTBDRsl Ver 2.0 assay is a rapid and important tool for the diagnosis and molecular characterization of second-line drug resistance under programmatic conditions.

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Section: Discussionsupporting

confidence: 85%

Second-line Drug Resistance Characterization in Mycobacterium tuberculosis by Genotype MTBDRsl Assay

Sethi¹,

Agarwal²,

Khaneja³

et al. 2020

JEGH

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“…A total of 104/562 isolates (18.5%) were found to be resistant to FQs. A high prevalence of FQ resistance was also reported in other provinces of Pakistan [10,13] and in the neighboring countries of India [14,15], China [16,17], and Bangladesh [18,19].…”

Section: Discussionmentioning

confidence: 69%

Fluoroquinolone resistance and mutational profile of gyrA in pulmonary MDR tuberculosis patients

Kabir

Tahir

Mukhtar

et al. 2020

Preprint

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Background Fluoroquinolones (FQs) are potential drugs that inhibit DNA synthesis and are used in the treatment of multidrug-resistant tuberculosis (TB) and short-term anti-TB regimens. In recent years, a high proportion of FQ resistance has been observed in Mycobacterium tuberculosis isolates. The development of FQ resistance in multidrug-resistant TB negatively impacts patient treatment outcome and is a serious threat to control of TB. Methods The study included a total of 562 samples from patients with pulmonary TB that had been on anti-tuberculosis therapy. MTBDRsl assays were performed for the molecular detection of mutations. Sequence analysis was performed for the characterization and mutational profiling of FQ-resistant isolates. Results FQ resistance was observed in 104 samples (18.5%), most of which were previously treated and treatment failure cases. A total of 102 isolates had mutations in DNA gyrase subunit A (gyrA), while mutations in gyrB were observed in only two isolates. Mutational analysis revealed that the mutations mostly alter codons 94 (replacing aspartic acid with glycine, D94G) and 90 (replacing alanine with valine, A90V). In MDR and treatment failure cases, resistance to FQs was most commonly associated with the D94G mutation. In contract, a high proportion of A90V mutations were observed in isolates that were newly diagnosed. Conclusion The findings suggest that genotypic assays for FQ resistance should be carried out at the time of initial diagnosis, before starting treatment, in order to rule out mutations that impact the potential use of FQs in treatment and to control drug resistance.

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“…This provides a mandate for performing drug susceptibility testing for other drugs before considering the patient as a case of MDR TB. Another study conducted by Sharma et al 18 studied the pattern of drug resistance in second-line drugs in MDR TB patients. They concluded that 40% of the patients started empirically with multidrug regimens were already resistant to one or the other drugs.…”

Section: Discussionmentioning

confidence: 99%

Pattern of Drug Resistance in Primary Spinal Tuberculosis: A Single-Center Study From India

Bhosale¹,

Prabhakar

Srivastava³

et al. 2020

Global Spine Journal

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Study Design: Retrospective observational analysis. Objectives: Spinal tuberculosis accounts for about 50% of cases among extra pulmonary osteoarticular tuberculosis. Resistance to drugs in spinal tuberculosis patients is on a rise and there is inadequate literature concentrating on the precise pattern of resistance in Indian subcontinent which harbors 24% of global prevalence. The aim was to study the pattern of drug resistance in spinal tuberculosis among first- and second-line drugs. Drug resistance is common in spinal tuberculosis and we intended to find the prevalence of various drug resistance patterns. Methods: Patients with spinal tuberculosis visiting a tertiary center were assessed. Samples were taken from the affected vertebrae and sent for BACTEC mycobacterium growth indicator tube (MGIT) 960 culture. Patients with a positive growth in MGIT were included in the study. All previously treated patients (relapse, treatment after failure, treatment after loss to follow-up and other previously treated patients) were excluded. Results: A total of 150 patients with a positive growth in MGIT report were included in the study, of whom 43 patients had some kind of drug resistance. Seven were multidrug resistant (MDR), 9 had preextensive drug resistance (pre-XDR), and 4 had extensive drug resistance (XDR). Seventeen patients had mono-drug resistance, which was most frequently for isoniazid. Resistance among second-line drugs was common in the fluoroquinolone group. Conclusion: Drug resistance in spinal tuberculosis was found to be 28.6%. Of these, MDR was in 16.2%, pre-XDR in 20.9%, and XDR in 9.3% patients.

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A study on pattern of resistance to second line anti tubercular drugs among multi drug resistant tuberculosis patients

Cited by 9 publications

References 11 publications

Second-line Drug Resistance Characterization in Mycobacterium tuberculosis by Genotype MTBDRsl Assay

Second-line Drug Resistance Characterization in Mycobacterium tuberculosis by Genotype MTBDRsl Assay

Fluoroquinolone resistance and mutational profile of gyrA in pulmonary MDR tuberculosis patients

Pattern of Drug Resistance in Primary Spinal Tuberculosis: A Single-Center Study From India

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