Drug-resistance characteristics, genetic diversity, and transmission dynamics of multidrug-resistant or rifampicin-resistant Mycobacterium tuberculosis from 2019 to 2021 in Sichuan, China.

IF 4.8 2区 医学 Q1 INFECTIOUS DISEASES Antimicrobial Resistance and Infection Control Pub Date : 2024-10-14 DOI:10.1186/s13756-024-01482-6
Wenfeng Gao, Weina Wang, Jing Li, Yuan Gao, Shu Zhang, Hui Lei, Lu He, Ting Li, Jinge He
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Abstract

Background: Multidrug- or rifampicin-resistant tuberculosis (TB; MDR/RR-TB) is a significant public health threat. However, the mechanisms involved in its transmission in Sichuan, China are unclear. To provide a scientific basis for MDR/RR-TB control and prevention, we investigated the drug-resistance characteristics, genetic diversity, and transmission dynamics and analyzed the demographic and clinical characteristics of patients to identify risk factors for the acquisition of MDR/RR-TB in Sichuan, Western China.

Methods: Whole-genome sequencing was performed using a sample comprised of all MDR/RR-TB strains isolated from patients with pulmonary TB (≥ 15 years) at the 22 surveillance sites in Sichuan province between January 2019 and December 2021, to analyze genotypic drug resistance and genetic diversity. Moreover, we performed statistical analyses of the epidemiological characteristics and risk factors associated with the transmission dynamics of MDR/RR-TB.

Results: The final analysis included 278 MDR/RR TB strains. Lineage 2.2, the major sub-lineage, accounted for 82.01% (228/278) of isolates, followed by lineage 4.5 (9.72%, 27/278), lineage 4.4 (6.83%, 19/278), and lineage 4.2 (1.44%, 4/278). The drug resistance rates, ranging from high to low, were as follows: isoniazid (229 [82.37%]), streptomycin (177 [63.67%]), ethambutol (144 [51.80%]), pyrazinamide (PZA, 119 [42.81%]), fluoroquinolones (FQs, 93 [33.45%]). Further, the clofazimine, bedaquiline, and delamanid resistance rates were 2.88, 2.88, and 1.04%, respectively. The gene composition cluster rate was 32.37% (90/278). In addition, 83.81% (233/278) of MDR/RR-TB cases were determined to be likely caused by transmission. Finally, patients infected with lineage two strains and strains with the KatG S315T amino acid substitution presented a higher risk of MDR/RR-TB transmission.

Conclusion: Transmission plays a significant role in the MDR/RR-TB burden in Sichuan province, and lineage 2 strains and strains harboring KatG S315T have a high probability of transmission. Further, high levels of FQ and PZA drug resistance suggest an urgent need for drug susceptibility testing prior to designing therapeutic regimens. New anti-TB drugs need to be used standardly and TB strains should be regularly monitored for resistance to these drugs.

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2019年至2021年中国四川耐多药或耐利福平结核分枝杆菌的耐药性特征、遗传多样性和传播动态。
背景:耐多药或耐利福平结核病(TB;MDR/RR-TB)是一个严重的公共卫生威胁。然而,其在中国四川的传播机制尚不清楚。为了给 MDR/RR-TB 的控制和预防提供科学依据,我们调查了耐药性特征、遗传多样性和传播动态,并分析了患者的人口和临床特征,以确定中国西部四川地区获得 MDR/RR-TB 的风险因素:在2019年1月至2021年12月期间,对四川省22个监测点从肺结核患者(≥15岁)中分离的所有MDR/RR-TB菌株进行全基因组测序,分析基因型耐药性和遗传多样性。此外,我们还对与MDR/RR-TB传播动态相关的流行病学特征和风险因素进行了统计分析:最终分析包括 278 株 MDR/RR 结核菌株。2.2系是主要的亚系,占分离株的82.01%(228株/278株),其次是4.5系(9.72%,27株/278株)、4.4系(6.83%,19株/278株)和4.2系(1.44%,4株/278株)。耐药率从高到低依次为:异烟肼(229 [82.37%])、链霉素(177 [63.67%])、乙胺丁醇(144 [51.80%])、吡嗪酰胺(PZA,119 [42.81%])、氟喹诺酮类(FQs,93 [33.45%])。此外,氯法齐明、贝达喹啉和delamanid的耐药率分别为2.88%、2.88%和1.04%。基因组成群集率为 32.37%(90/278)。此外,83.81%(233/278)的 MDR/RR-TB 病例被确定可能是由传播引起的。最后,感染二系菌株和 KatG S315T 氨基酸置换菌株的患者发生 MDR/RR-TB 传播的风险较高:结论:传播在四川省 MDR/RR-TB 负担中起着重要作用,2 系菌株和携带 KatG S315T 的菌株具有较高的传播可能性。此外,高水平的 FQ 和 PZA 耐药性表明,在设计治疗方案之前,迫切需要进行药敏试验。需要规范使用新的抗结核药物,并定期监测结核菌株对这些药物的耐药性。
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来源期刊
Antimicrobial Resistance and Infection Control
Antimicrobial Resistance and Infection Control PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -INFECTIOUS DISEASES
CiteScore
9.70
自引率
3.60%
发文量
140
审稿时长
13 weeks
期刊介绍: Antimicrobial Resistance and Infection Control is a global forum for all those working on the prevention, diagnostic and treatment of health-care associated infections and antimicrobial resistance development in all health-care settings. The journal covers a broad spectrum of preeminent practices and best available data to the top interventional and translational research, and innovative developments in the field of infection control.
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