Genetic sequencing for surveillance of drug resistance in tuberculosis in highly endemic countries: a multi-country population-based surveillance study

作者：Matteo Zignol, Andrea Maurizio Cabibbe, Anna Dean, Philippe Glaziou, Natavan Alikhanova, Cecilia Ama, Sönke Andres, A. I. Barbova, Angeli Borbe-Reyes, Daniel P. Chin, Daniela María Cirillo, Charlotte Colvin, Andrei Dadu, Andries Dreyer, Michèle Driesen, Christopher Gilpin, Rumina Hasan, Zahra Hasan, Sven Hoffner, Azhar Hussain, Nazir Ismail, S. M. Mostofa Kamal, Faisal Masood Khanzada, Michael Kimerling, Thomas A. Kohl, Mikael Mansjö, Paolo Miotto, Ya Diul Mukadi, Lindiwe Mvusi, Stefan Niemann, Shaheed Vally Omar, Leen Rigouts, Marco Schito, Ivita Sela, Mehriban Seyfaddinova, Girts Skenders, Alena Skrahina, Sabira Tahseen, William A. Wells, Alexander Zhurilo, Karin Weyer, Katherine Floyd, Mario Raviǵlione · 发表于：The Lancet Infectious Diseases · 年份：2018 · DOI：10.1016/s1473-3099(18)30073-2 · 被引用次数：161 · 研究领域：Tuberculosis Research and Epidemiology、Diagnosis and treatment of tuberculosis、Malaria Research and Control

BACKGROUND: In many countries, regular monitoring of the emergence of resistance to anti-tuberculosis drugs is hampered by the limitations of phenotypic testing for drug susceptibility. We therefore evaluated the use of genetic sequencing for surveillance of drug resistance in tuberculosis. METHODS: Population-level surveys were done in hospitals and clinics in seven countries (Azerbaijan, Bangladesh, Belarus, Pakistan, Philippines, South Africa, and Ukraine) to evaluate the use of genetic sequencing to estimate the resistance of Mycobacterium tuberculosis isolates to rifampicin, isoniazid, ofloxacin, moxifloxacin, pyrazinamide, kanamycin, amikacin, and capreomycin. For each drug, we assessed the accuracy of genetic sequencing by a comparison of the adjusted prevalence of resistance, measured by genetic sequencing, with the true prevalence of resistance, determined by phenotypic testing. FINDINGS: Isolates were taken from 7094 patients with tuberculosis who were enrolled in the study between November, 2009, and May, 2014. In all tuberculosis cases, the overall pooled sensitivity values for predicting resistance by genetic sequencing were 91% (95% CI 87-94) for rpoB (rifampicin resistance), 86% (74-93) for katG, inhA, and fabG promoter combined (isoniazid resistance), 54% (39-68) for pncA (pyrazinamide resistance), 85% (77-91) for gyrA and gyrB combined (ofloxacin resistance), and 88% (81-92) for gyrA and gyrB combined (moxifloxacin resistance). For nearly all drugs and in mos...