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Article

Resistance Profiles to Second-Line Anti-Tuberculosis Drugs and Their Treatment Outcomes: A Three-Year Retrospective Analysis from South India

by
Radha Gopalaswamy
1,†,
Nandhini Palani
1,†,
Dinesh Viswanathan
1,
Bershila Preysingh
1,
Suchithra Rajendran
1,
Vaishnavee Vijayaraghavan
1,
Kannadasan Thangavel
1,
Senthil Devi Vadivel
1,
Hannah Stanley
1,
Kannan Thiruvengadam
1,
Lavanya Jayabal
2,
Kaleeswari Murugesan
3,
Sridhar Rathinam
4,
Asha Frederick
5,
Gomathi Sivaramakrishnan
1,
Chandrasekaran Padmapriyadarsini
1 and
Sivakumar Shanmugam
1,*
1
ICMR-National Institute for Research in Tuberculosis, Chennai 600031, India
2
District TB, Chennai 600056, India
3
District TB, Kancheepuram 631502, India
4
GHTM, Tambaram, Chennai 600047, India
5
State TB, Sathumadural 600006, India
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
Medicina 2023, 59(6), 1005; https://doi.org/10.3390/medicina59061005
Submission received: 30 March 2023 / Revised: 12 May 2023 / Accepted: 19 May 2023 / Published: 23 May 2023
(This article belongs to the Section Infectious Disease)
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Abstract

Background: Patients with first-line drug resistance (DR) to rifampicin (RIF) or isoniazid (INH) as a first-line (FL) line probe assay (LPA) were subjected to genotypic DST using second-line (SL) LPA to identify SL-DR (including pre-XDR) under the National TB Elimination Program (NTEP), India. SL-DR patients were initiated on different DR-TB treatment regimens and monitored for their outcomes. The objective of this retrospective analysis was to understand the mutation profile and treatment outcomes of SL-DR patients. Materials and Methods: A retrospective analysis of mutation profile, treatment regimen, and treatment outcome was performed for SL-DR patients who were tested at ICMR-NIRT, Supra-National Reference Laboratory, Chennai between the years 2018 and 2020. All information, including patient demographics and treatment outcomes, was extracted from the NTEP Ni-kshay database. Results: Between 2018 and 2020, 217 patients out of 2557 samples tested were identified with SL-DR by SL-LPA. Among them, 158/217 were FQ-resistant, 34/217 were SLID-resistant, and 25/217 were resistant to both. D94G (Mut3C) of gyrA and a1401g of rrs were the most predominant mutations in the FQ and SLID resistance types, respectively. Favorable (cured and treatment complete) and unfavorable outcomes (died, lost to follow up, treatment failed, and treatment regimen changed) were recorded in a total of 82/217 and 68/217 patients in the NTEP Ni-kshay database. Conclusions: As per the testing algorithm, SL- LPA is used for genotypic DST following identification of first-line resistance, for early detection of SL-DR in India. The fluoroquinolone resistance pattern seen in this study population corelates with the global trend. Early detection of fluoroquinolone resistance and monitoring of treatment outcome can help achieve better patient management.
Keywords: fluoroquinolone; resistance; treatment regimen; mutations; LPA; NGS fluoroquinolone; resistance; treatment regimen; mutations; LPA; NGS

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MDPI and ACS Style

Gopalaswamy, R.; Palani, N.; Viswanathan, D.; Preysingh, B.; Rajendran, S.; Vijayaraghavan, V.; Thangavel, K.; Vadivel, S.D.; Stanley, H.; Thiruvengadam, K.; et al. Resistance Profiles to Second-Line Anti-Tuberculosis Drugs and Their Treatment Outcomes: A Three-Year Retrospective Analysis from South India. Medicina 2023, 59, 1005. https://doi.org/10.3390/medicina59061005

AMA Style

Gopalaswamy R, Palani N, Viswanathan D, Preysingh B, Rajendran S, Vijayaraghavan V, Thangavel K, Vadivel SD, Stanley H, Thiruvengadam K, et al. Resistance Profiles to Second-Line Anti-Tuberculosis Drugs and Their Treatment Outcomes: A Three-Year Retrospective Analysis from South India. Medicina. 2023; 59(6):1005. https://doi.org/10.3390/medicina59061005

Chicago/Turabian Style

Gopalaswamy, Radha, Nandhini Palani, Dinesh Viswanathan, Bershila Preysingh, Suchithra Rajendran, Vaishnavee Vijayaraghavan, Kannadasan Thangavel, Senthil Devi Vadivel, Hannah Stanley, Kannan Thiruvengadam, and et al. 2023. "Resistance Profiles to Second-Line Anti-Tuberculosis Drugs and Their Treatment Outcomes: A Three-Year Retrospective Analysis from South India" Medicina 59, no. 6: 1005. https://doi.org/10.3390/medicina59061005

APA Style

Gopalaswamy, R., Palani, N., Viswanathan, D., Preysingh, B., Rajendran, S., Vijayaraghavan, V., Thangavel, K., Vadivel, S. D., Stanley, H., Thiruvengadam, K., Jayabal, L., Murugesan, K., Rathinam, S., Frederick, A., Sivaramakrishnan, G., Padmapriyadarsini, C., & Shanmugam, S. (2023). Resistance Profiles to Second-Line Anti-Tuberculosis Drugs and Their Treatment Outcomes: A Three-Year Retrospective Analysis from South India. Medicina, 59(6), 1005. https://doi.org/10.3390/medicina59061005

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