Predicting Extensively Drug-Resistant Mycobacterium tuberculosis Phenotypes with Genetic Mutations

Molecular diagnostic methods based on the detection of mutations conferring drug resistance are promising technologies for rapidly detecting multidrug-/extensively drug-resistant tuberculosis (M/XDR TB), but large studies of mutations as markers of resistance are rare. The Global Consortium for Drug-Resistant TB Diagnostics analyzed 417Mycobacterium tuberculosis isolates from multinational sites with a high prevalence of drug resistance to determine the sensitivities and specificities of mutations associated with M/XDR TB to inform the development of rapid diagnostic methods. We collected M/XDR TB isolates from regions of high TB burden in India, Moldova, the Philippines, and South Africa. The isolates underwent standardized phenotypic drug susceptibility testing (DST) to isoniazid (INH), rifampin (RIF), moxifloxacin (MOX), ofloxacin (OFX), amikacin (AMK), kanamycin (KAN), and capreomycin (CAP) using MGIT 960 and WHO-recommended critical concentrations. Eight genes (katG ,inhA ,rpoB ,gyrA ,gyrB ,rrs ,eis , andtlyA ) were sequenced using Sanger sequencing. Three hundred seventy isolates were INHr , 356 were RIFr , 292 were MOXr /OFXr , 230 were AMKr , 219 were CAPr , and 286 were KANr . Four single nucleotide polymorphisms (SNPs) inkatG /inhA had a combined sensitivity of 96% and specificities of 97 to 100% for the detection of INHr . Eleven SNPs inrpoB had a combined sensitivity of 98% for RIFr . Eight SNPs ingyrA codons 88 to 94 had sensitivities of 90% for MOXr /OFXr . Therrs 1401/1484 SNPs had 89 to 90% sensitivity for detecting AMKr /CAPr but 71% sensitivity for KANr . Addingeis promoter SNPs increased the sensitivity to 93% for detecting AMKr and to 91% for detecting KANr . Approximately 30 SNPs in six genes predicted clinically relevant XDR-TB phenotypes with 90 to 98% sensitivity and almost 100% specificity.