Massachusetts Supranational TB Reference Laboratory; Department of Pediatrics
Bacterial Infections and Mycoses | Health Services Administration | Health Services Research | Infectious Disease
Background: Rifampicin resistant tuberculosis (RR-TB) was frequently detected in Suriname after the introduction of Xpert MTB/RIF in 2012. Subsequent phenotypic drug-susceptibility testing (DST) was not conclusive at that moment, while RR-TB patients treated with first-line tuberculostatics had good treatment outcome. In our study, we analysed this interesting observation.
Methods: We collected demographic and clinical characteristics and treatment outcome of TB patients from May 2012-December 2018 and performed a univariate and multivariate analysis to assess possible associations with resistance to rifampicin. Secondly, we conducted whole genome sequencing on all available Mycobacterium tuberculosis isolates that had a rifampicin resistance in the Xpert MTB/RIF test and performed phenotypic DST on selected isolates.
Findings: RR-TB was detected in 59 (9.6%) patients confirmed by Xpert. These patients were treated with rifampicin-containing regimens in most (88%) of the cases. In all 32 samples examined, a D435Y mutation in the rpoB gene was identified; only one isolate revealed an additional isoniazid mutation. Phenotypic DST indicated low-level rifampicin resistance. In multivariate analysis, the Creole ethnicity was a factor associated with rifampicin resistance (aOR 3.5; 95%CI 1.9-6.4). The treatment success rate for patients with RR-TB (78.0%) was comparable to the treatment outcome in non-RR-TB patients 77.8%.
Interpretation: This study confirms a low-level rifampicin mono-resistance in TB patients of Suriname. These patients could benefit from a first-line regimen with high dose rifampicin (or rifabutin), rather than from the lengthy treatment regimens for rifampicin-resistant and multi-drug resistant TB, a concept of stratified medicine also advocated for the treatment of TB.
Drug resistance, Drug-susceptibility testing, Treatment Outcome, Tuberculosis, Xpert MTB/RIF
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Copyright © 2021 The Authors. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
DOI of Published Version
Gopie FA, Commiesie E, Baldi S, Kamst M, Kaur D, de Lange WCM, Pinas PS, Stijnberg D, Wongsokarijo M, Zijlmans CWR, de Zwaan R, van Soolingen D, Vreden SGS, de Vries G. Should treatment of low-level rifampicin mono-resistant tuberculosis be different? J Clin Tuberc Other Mycobact Dis. 2021 Jan 29;23:100222. doi: 10.1016/j.jctube.2021.100222. PMID: 33598570; PMCID: PMC7869001. Link to article on publisher's site
Journal of clinical tuberculosis and other mycobacterial diseases
Gopie FA, Commiesie E, Baldi S, Kamst M, Kaur D, de Lange WC, Pinas PS, Stijnberg D, Wongsokarijo M, Zijlmans CW, de Zwaan R, van Soolingen D, Vreden SG, de Vries G. (2021). Should treatment of low-level rifampicin mono-resistant tuberculosis be different. Open Access Publications by UMMS Authors. https://doi.org/10.1016/j.jctube.2021.100222. Retrieved from https://escholarship.umassmed.edu/oapubs/4549
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