ArticleNature communications2023
The relative transmission fitness of multidrug-resistant Mycobacterium tuberculosis in a drug resistance hotspot.
Article in Nature communications, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 41 papers.
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41 citing papers in PubMed, 69 citations in OpenAlex.
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- The global phylogeography of rapidly expanding multidrug resistant Ural lineage 4.2 Mycobacterium tuberculosis.Nature communications · 2026Article
- Genome-wide analyses of Mycobacterium tuberculosis complex isolates reveal insights into circulating lineages and drug resistance mutations in The Gambia.Scientific reports · 2026Article
- Within-host evolution of drug tolerance inJAC-antimicrobial resistance · 2026Article
- Transmission heterogeneity amongiScience · 2026Article
- Drug resistance patterns and associated risk factors in pulmonary tuberculosis patients from selected hospitals in Ghana.BMC infectious diseases · 2026Article
- Beyond Hotspot Mutations: Diagnostic Relevance of High Frequency, Low Frequency, and DisputedPathogens (Basel, Switzerland) · 2025Review
- Current drug susceptibility testing in the Löwenstein-Jensen medium leads to underestimating of prothionamide resistance in multi-drug resistant Mycobacterium tuberculosis.BMC microbiology · 2025Article
- Variability in intrinsic drug tolerance inAntimicrobial agents and chemotherapy · 2025Article
- Analyzing the distribution of virulence factors ofVirulence · 2025Article
- Unraveling Epistatic Interactions Between Sites Under Drug-Dependent Selection in the Mycobacterium tuberculosis Genome.Molecular biology and evolution · 2025Article
- Mycobacterium tuberculosis complex Lineage 1: A neglected cause of tuberculosis.PLoS neglected tropical diseases · 2025Review
- Ecology, global diversity and evolutionary mechanisms in the Mycobacterium tuberculosis complex.Nature reviews. Microbiology · 2025Review
- Within-host bacterial evolution and the emergence of pathogenicity.Nature microbiology · 2025Review
- Evaluation of the role ofMicrobiology spectrum · 2025Article
- Dissecting rifampicin heteroresistance inJournal of medical microbiology · 2025Article
- Sentinel-Site-Based Surveillance ofAntibiotics (Basel, Switzerland) · 2025Article
- Bayesian Phylodynamic Inference of Multitype Population Trajectories Using Genomic Data.Molecular biology and evolution · 2025Article
Corrections and comments
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Authors and funding
20 authors at 4 institutions in 2 countries.
Funding
Abstract
Multidrug-resistant tuberculosis (MDR-TB) is among the most frequent causes of death due to antimicrobial resistance. Although only 3% of global TB cases are MDR, geographical hotspots with up to 40% of MDR-TB have been observed in countries of the former Soviet Union. While the quality of TB control and patient-related factors are known contributors to such hotspots, the role of the pathogen remains unclear. Here we show that in the country of Georgia, a known hotspot of MDR-TB, MDR Mycobacterium tuberculosis strains of lineage 4 (L4) transmit less than their drug-susceptible counterparts, whereas most MDR strains of L2 suffer no such defect. Our findings further indicate that the high transmission fitness of these L2 strains results from epistatic interactions between the rifampicin resistance-conferring mutation RpoB S450L, compensatory mutations in the RNA polymerase, and other pre-existing genetic features of L2/Beijing clones that circulate in Georgia. We conclude that the transmission fitness of MDR M. tuberculosis strains is heterogeneous, but can be as high as drug-susceptible forms, and that such highly drug-resistant and transmissible strains contribute to the emergence and maintenance of hotspots of MDR-TB. As these strains successfully overcome the metabolic burden of drug resistance, and given the ongoing rollout of new treatment regimens against MDR-TB, proper surveillance should be implemented to prevent these strains from acquiring resistance to the additional drugs.
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