ArticleGenome medicine2020
MDR M. tuberculosis outbreak clone in Eswatini missed by Xpert has elevated bedaquiline resistance dated to the pre-treatment era.
Article in Genome medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 53 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
53 citing papers in PubMed, 1 synthesis or guideline pooled it, 82 citations in OpenAlex.
- Genetic variants and their association with phenotypic resistance to bedaquiline inThe Lancet. Microbe · 2021Pooled it
- Targeted next-generation sequencing implementation in Eswatini identifies rifampicin and bedaquiline resistance undetected by routine diagnostic testing.Nature communications · 2026Article
- High treatment success among individuals with rifampicin-resistant tuberculosis in Botswana: A retrospective cohort study.Journal of infection and public health · 2026Article
- Tuberculosis transmission and resistance among Ukrainian migrants and its impact on multidrug-resistant tuberculosis dynamics in high-influx host countries.BMC microbiology · 2026Article
- Therapeutic drug monitoring-guided treatment of XDR TB with an RpoB I491F mutation-a case report.JAC-antimicrobial resistance · 2026Article
- Transmission of bedaquiline-resistant Mycobacterium tuberculosis in KwaZulu-Natal, South Africa.American journal of respiratory and critical care medicine · 2026Article
- Lineages of Mycobacterium tuberculosis complex associated with pulmonary drug-resistant tuberculosis in Africa: a systematic review.BMJ public health · 2026Article
- Undetected rifampicin-resistant tuberculosis associated with rpoB I491F and V170F mutations in Botswana: Diagnostic implications.Journal of global antimicrobial resistance · 2026Article
- Article
- Single-Sample Melt-Based Screening for Rifampicin Susceptibility in the Emerging Mutation Hotspot atACS infectious diseases · 2025Article
- Evaluation of the role ofMicrobiology spectrum · 2025Article
- Healthcare providers' knowledge, attitudes, and perceptions from using targeted sequencing to diagnose and manage drug-resistant tuberculosis (DR-TB) in Eswatini.PLOS global public health · 2025Article
- Population structure and emergence of resistance to new and repurposed drugs in XDR-TB: insights from a 10-year genomic study in the Western Cape, South Africa review.Frontiers in cellular and infection microbiology · 2025Article
- Letter to the Editor: First detection of aEuro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin · 2024Article
- Article
- Detection of multidrug-resistance in Mycobacterium tuberculosis by phenotype- and molecular-based assays.Annals of clinical microbiology and antimicrobials · 2024Article
- First detection of aEuro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin · 2024Article
- A composite reference standard is needed for bedaquiline antimicrobial susceptibility testing forThe European respiratory journal · 2024Article
- Sustained transmission over two decades of a previously unrecognised MPT64 negativeThe Lancet regional health. Western Pacific · 2024Article
- Genetic Characterization and Population Structure of Drug-ResistantAntibiotics (Basel, Switzerland) · 2024Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
23 authors at 12 institutions in 7 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundMultidrug-resistant (MDR) Mycobacterium tuberculosis complex strains not detected by commercial molecular drug susceptibility testing (mDST) assays due to the RpoB I491F resistance mutation are threatening the control of MDR tuberculosis (MDR-TB) in Eswatini.
methodsWe investigate the evolution and spread of MDR strains in Eswatini with a focus on bedaquiline (BDQ) and clofazimine (CFZ) resistance using whole-genome sequencing in two collections ((1) national drug resistance survey, 2009-2010; (2) MDR strains from the Nhlangano region, 2014-2017).
resultsMDR strains in collection 1 had a high cluster rate (95%, 117/123 MDR strains) with 55% grouped into the two largest clusters (gCL3, n = 28; gCL10, n = 40). All gCL10 isolates, which likely emerged around 1993 (95% highest posterior density 1987-1998), carried the mutation RpoB I491F that is missed by commercial mDST assays. In addition, 21 (53%) gCL10 isolates shared a Rv0678 M146T mutation that correlated with elevated minimum inhibitory concentrations (MICs) to BDQ and CFZ compared to wild type isolates. gCL10 isolates with the Rv0678 M146T mutation were also detected in collection 2.
conclusionThe high clustering rate suggests that transmission has been driving the MDR-TB epidemic in Eswatini for three decades. The presence of MDR strains in Eswatini that are not detected by commercial mDST assays and have elevated MICs to BDQ and CFZ potentially jeopardizes the successful implementation of new MDR-TB treatment guidelines. Measures to limit the spread of these outbreak isolates need to be implemented urgently.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.