Analysis of drug resistance among difficult-to-treat tuberculosis patients in Ghana identifies several pre-XDR TB cases

• DOI: 10.3389/fmicb.2022.1069292
• Publication Date: 2023-01-12T06:21:05Z
• Authors: Isaac Darko Otchere; Portia Abena Morgan; Prince Asare; Stephen Osei-Wusu; Samuel Yaw Aboagye; Stephen Ofori Yir...; Abdul Basit Musah; Emelia Konadu Danso; Georgina Tetteh-O...; Theophilus Afum; Adwoa Asante-Poku; Clement Laryea; Yaw Adusi Poku; Frank Bonsu; Sebastien Gagneux; Dorothy Yeboah-Manu
• Keywords: 0301 basic medicine; Genotype; Epidemiology; FOS: Basic medicine; FOS: Health sciences; Ghana; Microbiology; Gene; Global Challenge of Antibiotic Resistance in Bacteria; 03 medical and health sciences; Kanamycin; Antibiotics; Biochemistry, Genetics and Molecular Biology; Health Sciences; Isoniazid; Pathology; Genetics; Tuberculosis; Capreomycin; Extensively drug-resistant tuberculosis; Ethionamide; pre-XDR-TB; Amikacin; Internal medicine; Biology; Management and Epidemiology of Pneumonia; Rifampicin; Pharmacology; drug resistance; screening; Sputum; Life Sciences; Mycobacterium tuberculosis; QR1-502; 3. Good health; monitoring; Infectious Diseases; tuberculosis; Drug resistance; FOS: Biological sciences; Medicine; Molecular Medicine; Antimicrobial Resistance; Drug; Ethambutol

BackgroundResistance 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.MethodsSputum 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.ResultsA 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.ConclusionThe 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.