Molecular characteristics of fluoroquinolone-resistant Mycobacterium tuberculosis strains from newly diagnosed tuberculosis patients in the Northwest of Russia

Introduction. Fluoroquinolones remain the key second-line anti-tuberculosis drugs. The aim of the study was the molecular characterization of fluoroquinolone-resistant Mycobacterium tuberculosis strains from newly diagnosed tuberculosis patients in the Northwest of the Russian Federation. Materials and methods. The retrospective study collection included M. tuberculosis isolates isolated in 2015–2019 from previously untreated tuberculosis patients. Susceptibility to antituberculosis drugs (including the fluoroquinolone ofloxacin) was determined using the BACTEC MGIT960 or absolute concentration method. Mutations in the gyrA gene as a marker of resistance to fluoroquinolones, were detected by real-time PCR. Beijing genotype and its subtypes were detected by PCR and real-time PCR methods. Non-Beijing strains were spoligotyped. Results and discussion. Phenotypic resistance to ofloxacin was detected in 6.7% (40/599) of strains and in 17.4% (40/230) of MDR strains. 34 of 40 (85%) ofloxacin-resistant strains belonged to the Beijing genotype. 18 (45%) strains were assigned to the Russian epidemic subtype Beijing B0/W148 and 12 (30%) to Beijing Central Asian/Russian. The remaining 6 ofloxacin-resistant strains belonged to the Euro-American phylogenetic lineage. Mutations in the gyrA gene were found in 97.5% (39/40) of strains. The most common were mutations in codon 94 (69.2%, 27/39). The Asp94Gly substitution was identified in 57.5% (23/40) of ofloxacin-resistant strains and was dominant among Beijing (19/34) and non-Beijing (4/6) strains. The second most common substitution was Ala90Val (25%, 10/40). More than half of the ofloxacin-resistant strains, Beijing B0/W148 (10/18) and Central Asian/Russian (7/12), carried the Asp94Gly mutation. Conclusion. In the Northwest of Russia in 2016-2019, primary resistance of M. tuberculosis to fluoroquinolones was 6.7% in the total collection and 17.4% of MDR strains, and was mainly caused by the gyrA Asp94Gly and Ala90Val mutations. Beijing B0/W148 genotype was characterized by the largest proportion of fluoroquinolone-resistant strains.