Transmission patterns of rifampicin resistant Mycobacterium tuberculosis complex strains in Cameroon: a genomic epidemiological study

BMC Infectious Diseases

Jürgen Noeske¹  Christopher Kuaban²  Thomas A. Kohl³  Viola Dreyer³  Matthias Merker⁴  Stefan Niemann⁵  Comfort Vuchas⁶  Melissa S. Sander⁶  Yannick R. Ngangue⁶  Nkongho F. Egbe⁷ 

[1] Bamenda, Cameroon;Faculty of Health Sciences, University of Bamenda, Bamenda, Cameroon;Molecular and Experimental Mycobacteriology, Research Center Borstel, Borstel, Germany;Molecular and Experimental Mycobacteriology, Research Center Borstel, Borstel, Germany;Evolution of the Resistome, Research Center Borstel, Borstel, Germany;German Center for Infection Research, Partner Site Hamburg-Lübeck-Borstel-Riems, Borstel, Germany;Molecular and Experimental Mycobacteriology, Research Center Borstel, Borstel, Germany;German Center for Infection Research, Partner Site Hamburg-Lübeck-Borstel-Riems, Borstel, Germany;Tuberculosis Reference Laboratory Bamenda, Center for Health Promotion and Research, Bamenda, Cameroon;Tuberculosis Reference Laboratory Bamenda, Center for Health Promotion and Research, Bamenda, Cameroon;School of Life Sciences, College of Science, University of Lincoln, Lincoln, England, UK;

关键词: MDR-TB;    Mycobacterium tuberculosis;    Cameroon;    Transmission;   

DOI  :  10.1186/s12879-021-06593-8

来源: Springer

【 摘 要 】

BackgroundDetermining factors affecting the transmission of rifampicin (RR) and multidrug-resistant (MDR) Mycobacterium tuberculosis complex strains under standardized tuberculosis (TB) treatment is key to control TB and prevent the evolution of drug resistance.MethodsWe combined bacterial whole genome sequencing (WGS) and epidemiological investigations for 37% (n = 195) of all RR/MDR-TB patients in Cameroon (2012–2015) to identify factors associated with recent transmission.ResultsPatients infected with a strain resistant to high-dose isoniazid, and ethambutol had 7.4 (95% CI 2.6–21.4), and 2.4 (95% CI 1.2–4.8) times increased odds of being in a WGS-cluster, a surrogate for recent transmission. Furthermore, age between 30 and 50 was positively correlated with recent transmission (adjusted OR 3.8, 95% CI 1.3–11.4). We found high drug-resistance proportions against three drugs used in the short standardized MDR-TB regimen in Cameroon, i.e. high-dose isoniazid (77.4%), ethambutol (56.9%), and pyrazinamide (43.1%). Virtually all strains were susceptible to fluoroquinolones, kanamycin, and clofazimine, and treatment outcomes were mostly favourable (87.5%).ConclusionPre-existing resistance to high-dose isoniazid, and ethambutol is associated with recent transmission of RR/MDR strains in our study. A possible contributing factor for this observation is the absence of universal drug susceptibility testing in Cameroon, likely resulting in prolonged exposure of new RR/MDR-TB patients to sub-optimal or failing first-line drug regimens.

【 授权许可】

CC BY