Extract
Rifampicin drives the efficacy of the current first-line treatment regimen for tuberculosis (TB) [1]. Mutations in the rpoB gene cause rifampicin resistance (RR) of varying levels. Common mutations typically confer high-level, “high-confidence” resistance, providing a selective advantage to Mycobacterium tuberculosis during treatment at low fitness cost [2]. Growth-based phenotypic drug-susceptibility testing (pDST) is very reliable for high-confidence mutations. Mutations conferring low-level resistance at high fitness cost are easily lost during primary culture or will cause phenotypically false-susceptible results if not given enough time for growth, especially with the widely used automated MGIT 960 DST [3]. Due to disagreement on their significance, such rpoB mutations were called “disputed”.
Abstract
Despite their name, borderline rpoB mutations are correlated with unfavourable outcomes when rifampicin-throughout treatment is used. They may become the drivers of rifampicin-resistant tuberculosis. Second-line treatment is recommended. https://bit.ly/3nbkZjt
Acknowledgements
We thank the clinic and laboratory staff of Damien Foundation Bangladesh as well as the staff of the Mycobacteriology laboratory of the Institute of Tropical Medicine in Antwerp.
Footnotes
Data sharing statement: Deidentified individual participant data and a data dictionary, defining each field in the set, will be made available to others by the corresponding author after approval of the purpose of their use.
Author contributions: A. Van Deun conceived the study. A. Van Deun, K.J.M. Aung, M.A. Hossain and M. Gumusboga collected and prepared the Damien Foundation Bangladesh data. M.A. Hossain, M. Gumusboga and W.B. De Rijk conducted drug susceptibility testing. T. Decroo and A. Van Deun analysed the data. All co-authors contributed to the interpretation of the findings. A. Van Deun and T. Decroo wrote the first draft. All co-authors critically revised the subsequent versions and also approved the final version.
Conflict of interest: A. Van Deun has nothing to disclose.
Conflict of interest: T. Decroo has nothing to disclose.
Conflict of interest: K.J.M. Aung has nothing to disclose.
Conflict of interest: M.A. Hossain has nothing to disclose.
Conflict of interest: M. Gumusboga has nothing to disclose.
Conflict of interest: W.B. De Rijk has nothing to disclose.
Conflict of interest: S. Tahseen has nothing to disclose.
Conflict of interest: B.C. de Jong has nothing to disclose.
Conflict of interest: L. Rigouts has nothing to disclose.
- Received March 10, 2021.
- Accepted April 20, 2021.
- Copyright ©The authors 2021. For reproduction rights and permissions contact permissions{at}ersnet.org