The utility of luciferase reporter mycobacteriophages (LRPs) for detection, identification, and antibiotic susceptibility testing of Mycobacterium tuberculosis was prospectively evaluated in a clinical microbiology laboratory in Mexico City, Mexico. Five hundred twenty-three consecutive sputum samples submitted to the laboratory during a 5-month period were included in this study. These specimens were cultivated in Middlebrook 7H9 (MADC), MGIT, and Löwenstein-Jensen (LJ) media. Of the 71 mycobacterial isolates recovered with any of the three media, 76% were detected with the LRPs, 97% were detected with the MGIT 960 method, and 90% were detected with LJ medium. When contaminated specimens were excluded from the analysis, the LRPs detected 92% ( The microscopic examination of sputum to detect the presence of acid-fast bacilli (AFB) (AFB smear) has served the world well for the past 100 years and is the diagnostic basis of directly observed therapy. However, it fails to identify 30 to 50% of active cases of tuberculosis and cannot identify the increasing numbers of persons diseased by drug-resistant Mycobacterium tuberculosis (7, 10). A reliance solely upon the limited AFB smear is one of the many factors that contribute to poor tuberculosis control in resource-poor countries (1). Although available, conventional mycobacteriological techniques for culture isolation and antibiotic susceptibility testing (AST) are slow, and the more recently developed rapid methods such as the BACTEC and MGIT systems are expensive and require elaborate technology (3, 13, 15). Thus, there is an urgent need for a rapid and affordable method to detect mycobacteria in clinical specimens, to identify whether they are M. tuberculosis, and to determine their antimicrobial susceptibility.Over the past decade, luciferase reporter mycobacteriophages (LRPs) have been developed that show great promise for diagnostic microbiology (4). This novel approach utilizes a genetically engineered reporter phage to detect viable mycobacteria, which upon LRP infection produces quantifiable light. In the presence of antibiotics, bacilli that are drug resistant and retain their viability undergo phage infection and also produce light. In this way, quantification of photons with a luminometer can be used to reveal the susceptibility profile of each isolate. Unlike in the radiometric BACTEC system, the phages do not have any requirement for radioactive isotopes. When mycobacteria are grown in media containing agents such as p-nitro-␣-acetylamino--hydroxypropiophenone (NAP), selective inhibition of M. tuberculosis complex (MTC) organisms allows differentiation from nontuberculous mycobacteria (NTM) (11).To date, the performance of the LRPs for mycobacterial diagnostics has only been tested against a limited number of laboratory strains in a research laboratory (4,12). In this study we prospectively evaluated the diagnostic utility of the LRPs in a centralized diagnostic laboratory in Mexico City, Mexico. We showed (i) that LRP assay can rapidly and sensitively...